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1

Saphenous neuralgia after arthroscopically assisted anterior cruciate ligament reconstruction with a semitendinosus and gracilis tendon graft  

Microsoft Academic Search

Summary: A case report of saphenous neuralgia following arthroscopically assisted anterior cruciate ligament reconstruction with hamstring tendons is presented. The patient complained of paresthesia in the anteromedial region of the lower leg and tenderness at the medial side of the knee without motor or reflex abnormalities. Because saphenous neuralgia can mimic disorders of the knee, peripheral vascular disease, and lumbar

Christoph Bertram; Matthias Porsch; Matthias H. Hackenbroch; Ditmar Terhaag

2000-01-01

2

Patella fracture and proximal patellar tendon rupture following arthroscopic anterior cruciate ligament reconstruction.  

PubMed

The central one-third bone-patella tendon-bone graft is a popular choice for arthroscopic anterior cruciate ligament reconstruction. Complications following graft harvesting are unusual, but several reports have been published. We report an unusual case involving a simultaneous patella fracture and patellar tendon rupture that occurred 6 weeks postoperatively. PMID:10495182

Miller, M D; Nichols, T; Butler, C A

1999-09-01

3

Arthroscopic-assisted allograft anterior cruciate ligament reconstruction in patients with symptomatic arthrosis  

Microsoft Academic Search

We reviewed the results of arthroscopic-assisted anterior cruciate ligament (ACL) allograft reconstructions in 40 patients who had advanced articular cartilage deterioration documented by arthroscopy during the reconstruction. A mean of 7 years had elapsed between the original injury and the reconstruction, and 102 prior operative procedures had been done in 34 of the 40 patients. A total of 64 articular

Frank R. Noyes; Sue D. Barber-Westin

1997-01-01

4

Arthroscopic 4-Point Suture Fixation of Anterior Cruciate Ligament Tibial Avulsion Fractures  

PubMed Central

Tibial eminence avulsion fractures are rare injuries occurring mainly in adolescents and young adults. When necessary, regardless of patient age, anatomic reduction and stable internal fixation are mandatory for fracture healing and accurate restoration of normal knee biomechanics. Various arthroscopically assisted fixation methods with sutures, anchors, wires, or screws have been described but can be technically demanding, thus elongating operative times. The purpose of this article is to present a technical variation of arthroscopic suture fixation of anterior cruciate ligament avulsion fractures. Using thoracic drain needles over 2.4-mm anterior cruciate ligament tibial guidewires, we recommend the safe and easy creation of four 2.9-mm tibial tunnels at different angles and at specific points. This technique uses thoracic drain needles as suture passage cannulas and offers 4-point fixation stability, avoiding potential complications of bony bridge fracture and tunnel connection. PMID:25685674

Boutsiadis, Achilleas; Karataglis, Dimitrios; Agathangelidis, Filon; Ditsios, Konstantinos; Papadopoulos, Pericles

2014-01-01

5

Management of intraoperative complications in arthroscopic primary anterior cruciate ligament reconstruction.  

PubMed

Arthroscopic anterior cruciate ligament reconstruction is a commonly performed procedure which is technically demanding and involves multiple surgical steps with the potential for a wide range of intraoperative complications. In this article, we review these potential complications and give algorithms for dealing with them based on our experience and published evidence. We discuss the use of both bone-patellar tendon-bone and hamstring grafts and examine complications associated with suspensory button and interference screw fixation. PMID:24752920

Charalambous, Charalambos P; Alvi, Farhan; Sutton, Paul M

2015-04-01

6

Anatomic Anterior Cruciate Ligament Reconstruction With a Flexible Reamer System and 70° Arthroscope  

PubMed Central

Anterior cruciate ligament (ACL) reconstruction techniques continue to evolve as surgeons seek to improve surgical process and outcome measures. On the basis of published data showing improved biomechanics, many surgeons now attempt to better re-create native ACL anatomy in reconstruction. Use of flexible reamer technology and a 70° arthroscope allows for excellent visualization of the native ACL anatomy, as well as precise and independent drilling of the tibial and femoral reconstruction tunnels, while offering several surgical and technical advantages compared with other drilling techniques. This technical note with accompanying video describes our use of the Smith & Nephew Clancy anatomic cruciate guide/flexible drill system (Smith & Nephew, London, England) with a 70° arthroscope. PMID:24400174

Rasmussen, Jeffrey F.; Lavery, Kyle P.; Dhawan, Aman

2013-01-01

7

Intraligamentous ganglion cysts of the anterior cruciate Ligament: MR findings with clinical and arthroscopic correlations  

SciTech Connect

Magnetic resonance findings with clinical and arthroscopic correlation of intraligamentous cysts of the anterior cruciate ligament (ACL) are presented. Three cases of intraligamentous cysts of the ACL were identified out of 681 knee MRI examinations over a 2-year period. Arthroscopy and postoperative MRI were performed in all three patients, each of whom experienced knee pain with extreme flexion and extension. In all three cases the intraligamentous cyst was homogeneously hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging relative to the ACL. Two of the three ACL cysts required a 70{degrees} scope for adequate visualization and establishment of posteromedial and posterolateral portals for arthroscopic treatment. One cyst could not be visualized arthroscopically and probing of the ACL from the anterior portal resulted in drainage of the cyst. No patient had presence of ACL cyst on follow-up MRI or recurrence of symptoms at a mean of 24 months. Intraligamentous cyst of ACL is a rare cause of knee pain. It should be suspected in patients having chronic pain with extremes of motion. Magnetic resonance findings are diagnostic and help to guide arthroscopy. 14 refs., 3 figs.

Do-Dai, D.D.; Youngberg, R.A.; Lanchbury, F.D.; Pitcher, J.D. Jr.; Garver, T.H. [Madigan Army Medical Center, Tacoma, WA (United States)] [Madigan Army Medical Center, Tacoma, WA (United States)

1996-01-01

8

Graft infection following arthroscopic anterior cruciate ligament reconstruction: a report of four cases.  

PubMed

Septic arthritis following arthroscopic anterior cruciate ligament reconstruction (ACL) is a rare complication and associated with severe morbidity. Its risk factors include (1) concomitant procedures during the reconstruction, (2) previous knee surgery, (3) allograft usage, (4) peri-operative wound contamination, and (5) presence of intra-articular foreign bodies. We present a series of 3 men and one woman aged 22 to 35 years who developed septic arthritis following ACL reconstruction. The risk factors identified were local infection (n=2), previous ipsilateral knee surgery (n=2), and the use of an allograft (n=1). All patients underwent emergency knee washout and debridement with graft retention within 24 hours, together with a course of intravenous antibiotic therapy. All the patients achieved eradication of their infections (with intact ACL grafts) and satisfactory functional outcome at a mean follow-up of 32 (range, 25-45) months. PMID:24781628

Wee, James; Lee, Keng Thiam

2014-04-01

9

Septic arthritis caused by Erysipelothrix rhusiopathiae infection after arthroscopically assisted anterior cruciate ligament reconstruction.  

PubMed

A case of septic arthritis caused by Erysipelothrix rhusiopathiae, after an arthroscopically assisted anterior cruciate ligament (ACL) substitution in a non-immunosuppressed patient is described. An 18-year-old man underwent an ACL reconstruction with a quadruple hamstring graft. Eight days postoperatively, the patient developed fever, knee pain, and effusion without erythema or suppuration. He was readmitted to the hospital with the diagnosis of septic arthritis. The patient's erythrocyte sedimentation rate, C-reactive protein level, and white blood cell count were high. The joint was aspirated and the fluid was sent for cultures that revealed the presence of E rhusiopathiae. E rhusiopathiae is widespread in nature, it is transmitted by direct cutaneous laceration, and it causes septic arthritis, meningitis, endocarditis, and renal failure in immunosuppressed people with poor prognosis. In our case, the infection was treated with arthroscopic lavage and debridement, retention of the graft and hardware, and intravenous antibiotic administration for 6 weeks, followed by oral administration for 16 weeks. PMID:12627143

Allianatos, Panagiotis G V; Tilentzoglou, Anastasia C; Koutsoukou, Alexander D

2003-03-01

10

Massive bone loss from fungal infection after anterior cruciate ligament arthroscopic reconstruction.  

PubMed

Although there are numerous reports of septic pyogenic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction, there is limited information regarding the outcomes of fungal infection. We determined the outcomes of six patients with mycotic infection after regular ACL reconstruction. There were four males and two females with a mean age of 33 years. We determined the number of procedures performed, bone loss originating to control infection, and final reconstruction in these patients. An average of five arthroscopic lavage procedures had been performed at the referring centers. Fungal infection was diagnosed based on pathologic samples; five infections were the result of mucormycosis and one was Candida. After final débridement, the mean segmental bone loss was 12.8 cm. All patients were treated with intravenous antifungal coverage and cement spacers before final reconstruction. At final followup, all patients were free of clinical infection. Three had reconstruction with an allograft-prosthesis composite, two with hemicylindrical allografts, and one with an intercalary allograft arthrodesis. Despite the extremely unusual presentation of this complication, surgeons should be aware of potential and catastrophic consequences of this severe complication after ACL reconstruction. PMID:19190972

Muscolo, D Luis; Carbo, Lisandro; Aponte-Tinao, Luis A; Ayerza, Miguel A; Makino, Arturo

2009-09-01

11

The Use of Cold Therapy in the Postoperative Management of Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

In this prospective, randomized study we assessed the use of cold therapy after arthroscopic anterior cruciate ligament reconstruction. Seventy-one patients were randomly allocated, without the knowledge of the sin gle surgeon, to one of three groups: Group I had an ice water-filled CryoCuff fitted in the operating theater after surgery, Group II had room temperature water in the CryoCuff, and

Dennis J. Edwards; Martin Rimmer; Greg C. R. Keene

1996-01-01

12

Arthroscopic treatment of a large lateral femoral notch in acute anterior cruciate ligament tear.  

PubMed

A 24-year-old professional soccer player suffered an acute anterior cruciate ligament tear associated with a radiologically evident impression fracture of the lateral femoral condyle, the so-called "lateral femoral notch sign". Following MRI validation of the injury with detection of an additional lateral meniscus tear, arthroscopy was carried out 3 days after the injury. Due to the extended impression of about 5 mm, arthroscopically assisted closed reduction of the depression fracture was performed. A 3.2 mm tunnel was drilled at the lateral femoral condyle in a supero-inferior direction using an ACL tibial guide and the depressed area could be restored using an elevator. The resulting subchondral bone defect in the femoral condyle was filled with freeze-dried human cancellous bone allograft. As a one-stage procedure ACL reconstruction was carried out using a hamstring tendon technique. At 1-year follow up the patient has returned to full sporting function, including playing soccer with a radiographically reduced lateral femoral notch sign. PMID:18060552

Tauber, Mark; Fox, Michael; Koller, Heiko; Klampfer, Helmut; Resch, Herbert

2008-11-01

13

A 7Year Follow-up of Patellar Tendon and Hamstring Tendon Grafts for Arthroscopic Anterior Cruciate Ligament ReconstructionDifferences and Similarities  

Microsoft Academic Search

Background: For arthroscopic anterior cruciate ligament reconstruction, the most commonly used graft constructs are either the hamstring tendon or patellar tendon. Well-controlled, long-term studies are needed to determine the differences between the 2 materials.Hypothesis: There is a difference between hamstring and patellar tendon grafts in the clinical results of anterior cruciate ligament reconstructions at 7 years.Study Design: Cohort study; Level

Justin Roe; Leo A. Pinczewski; Vivianne J. Russell; Lucy J. Salmon; Tomomaro Kawamata; Melvin Chew

2005-01-01

14

Arthroscopic anterior cruciate ligament reconstruction using a flexible guide pin with a rigid reamer.  

PubMed

Successful anterior cruciate ligament reconstruction depends heavily on accurate placement of the graft within the anatomical insertion of the native anterior cruciate ligament. Inaccurate placement can lead to graft failure and recurrent instability. Flexible guide pins and reamers have been developed to overcome some of the limitations of using transtibial and anteromedial portals to drill femoral tunnels. Early in our experience with flexible instruments, reamer breakage caused complications. We therefore developed a technique that uses a flexible guide pin with a rigid reamer to place the femoral tunnel in an anatomical position. This technique allows placement of longer anatomical tunnels through an anteromedial portal, reduces time spent with the knee in hyperflexion, provides better viewing, poses less risk of damage to the articular cartilage and neurovascular structures, and at a lower cost with less risk of reamer breakage. PMID:25844586

Elliott, Michael P; Luedke, Colton C; Webb, Brian G

2015-04-01

15

Arthroscopically Assisted Combined Anterior and Posterior Cruciate Ligament Reconstruction with Autologous Hamstring Grafts–Isokinetic Assessment with Control Group  

PubMed Central

Objective The aim of the study was to: 1) evaluate the differences in pre-post operative knee functioning, mechanical stability, isokinetic knee muscle strength in simultaneous arthroscopic patients after having undergone an anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) with hamstring tendons reconstruction, 2) compare the results of ACL/PCL patients with the control group. Design Controlled Laboratory Study. Materials and Methods Results of 11 ACL/PCL patients had been matched with 22 uninjured control participants (CP). Prior to surgery, and minimum 2 years after it, functional assessment (Lysholm and IKDC 2000), mechanical knee joint stability evaluation (Lachman and “drawer” test) and isokinetic tests (bilateral knee muscle examination) had been performed. Different rehabilitation exercises had been used: isometric, passive exercises, exercises increasing the range of motion and proprioception, strength exercises and specific functional exercises. Results After arthroscopy no significant differences had been found between the injured and uninjured leg in all isokinetic parameters in ACL/PCL patients. However, ACL/PCL patients had still shown significantly lower values of strength in relative isokinetic knee flexors (p?=?0.0065) and extensors (p?=?0.0171) compared to the CP. There were no differences between groups regarding absolute isokinetic strength and flexors/extensors ratio. There was statistically significant progress in IKDC 2000 (p?=?0.0044) and Lysholm (p?=?0.0044) scales prior to (44 and 60 points respectively) and after the reconstruction (61 for IKDC 2000 and 94 points for Lysholm). Conclusions Although harvesting tendons of semitendinosus and/or gracilis from the healthy extremity diminishes muscle strength of knee flexors in comparison to the CP, flexor strength had improved. Statistically significant improvement of the knee extensor function may indicate that the recreation of joint mechanical stability is required for restoring normal muscle strength. Without restoring normal muscle function and strength, surgical intervention alone may not be sufficient enough to ensure expected improvement of the articular function. PMID:24386099

Piontek, Tomasz; Ciemniewska-Gorzela, Kinga; Szulc, Andrzej; Naczk, Jakub; Wardak, Martyna; Trzaska, Tadeusz; Dudzinski, Witold; Grygorowicz, Monika

2013-01-01

16

Meniscoligamentous band between the posterior horn of the lateral meniscus and the anterior cruciate ligament: arthroscopic, anatomical and histological observations  

Microsoft Academic Search

Background  Following the example of the anterior cruciate ligament reconstruction, the success of meniscus allograft transplantation\\u000a relies on good position of the graft and firm anchorage. The anatomy of the intercondylar region and the connections between\\u000a the cruciate ligament and the meniscal horns have been the subject of many surveys. However, as far as we know, there is only\\u000a one description

Ahmed Zemirline; Romain Gérard; Arnaud Uguen; Eric Stindel; Frédéric Dubrana

2010-01-01

17

Arthroscopic combined medial and lateral meniscus transplantation after double-tunnel, double-bundle anterior cruciate ligament reconstruction in the same knee.  

PubMed

Meniscus transplantation in combination with anterior cruciate ligament (ACL) reconstruction has been used in the treatment of patients with meniscus and ACL deficiency. However, there have been no reports of arthroscopic surgery and the outcome of both medial and lateral meniscus allograft transplantation after double-tunnel, double-bundle ACL reconstruction. Herein, we report the case of a young male who received arthroscopic lateral and medial meniscectomy and ACL tibialis allograft reconstruction performed with the double-tunnel and double-bundle technique approximately 8 months after a knee injury. Approximately 4 months postoperatively he began to experience pain and weakness in the operated knee and subsequently underwent arthroscopic lateral and medial meniscus allograft transplantation in the same procedure. Second-look arthroscopy and magnetic resonance imaging revealed the meniscal allografts to have normal shape and the ACL grafts to be relatively intact at 18 and 30 months after surgery. His knee appeared stable and the range of motion was normal. Our hypothesis was that knee stability could reliably be restored with this combined procedure and the meniscal grafts and ACL graft could provide protection for each other. We suggest that medial and lateral meniscus allografts for one patient should be from the same donor. In the operation, attention must be paid to the direction of the bone tunnels used to fix the horns of the meniscal grafts to avoid communication with other tunnels in the tibial plateau. PMID:22560745

Zhang, Ya-Dong; Hou, Shu-Xun; Zhang, Yi-Chao; Luo, Dian-Zhong; Zhong, Hong-Bin; Zhang, Hong

2012-12-01

18

[Anterior cruciate ligament ganglion: a case report].  

PubMed

Intraarticular ganglions are rare and they are usually incidental findings of MRIs and arthroscopies. We report the case of a male athlete with this condition affecting the anterior cruciate ligament. The most frequent symptoms include pain that worsens with activity, and motion limitations. The MRI shows the typical signs of a ganglion and it is the most specific and sensitive test. Arthroscopy is used for both the diagnosis and the treatment of this condition. A late diagnosis turns arthroscopic resection into a complicated or impossible procedure that at times warrants extensive debridement of the anterior cruzate ligament. PMID:24707614

Casas-Duhrkop, D; Ares, O; Seijas, R; Cugat, R; Català, J

2013-01-01

19

Complications of anterior cruciate ligament reconstruction: graft issues.  

PubMed

Anterior cruciate ligament reconstruction has become one of the most common arthroscopic procedures performed on the knee. Complications from this reconstructive surgery, although uncommon, can be devastating to the overall function of the knee. Several strategies exist to avoid potential complications related specifically to graft harvest and implantation, and to complications related to the bone-patellar tendon-bone and hamstring autografts, and patellar tendon allograft, the most common grafts currently used. PMID:16958483

Matava, Matthew J

2006-01-01

20

Current trends in anterior cruciate ligament reconstruction.  

PubMed

In 2006, a survey regarding anterior cruciate ligament (ACL) reconstruction was mailed to physician members of the American Orthopaedic Society for Sports Medicine. A total of 993 responses were received from 1747 possible respondents (57%). The number of ACL reconstructions per year ranged from 1 to 275 (mean=55). The most important factors in the timing of surgery were knee range of motion and effusion. Bone-patellar tendon-bone (BPTB) autograft was most commonly preferred (46%), followed by hamstring tendon autograft (32%) and allografts (22%). Five years earlier, BPTB grafts were more frequent and hamstring tendon and allografts were less frequent (63%, 25%, and 12%, respectively). A single-incision arthroscopic technique was used by 90%. Most allowed return to full activity at 5 to 6 months, with a trend toward earlier return for BPTB grafts; quadriceps strength was an important factor in the decision. There was limited experience (4%) with double-bundle and computer-assisted ACL reconstruction. Arthroscopic-assisted, single-incision reconstruction using a BPTB autograft fixed with metal interference screws remains the most common technique used for primary ACL reconstruction. In the past 5 years, the use of alternative graft sources and methods of fixation has increased. Consensus regarding the best graft type, fixation method, and postoperative protocol is still lacking. PMID:19216345

Duquin, Thomas R; Wind, William M; Fineberg, Marc S; Smolinski, Robert J; Buyea, Cathy M

2009-01-01

21

Comparison of arthroscopic anterior cruciate ligament reconstruction by bone-patellar tendon-bone graft with or without using interferential screw in general population.  

PubMed

Rupture of the Anterior Cruciate Ligament (ACL) is common, resulting reduced quality of life, increasing the meniscal injury risk, knee instability and early degenerative joint disease. Bone-Patellar Tendon-Bone (BPTB) became the gold standard surgery where conservative management failed. Adding interferential screw provides rigid fixation which is important for early accelerated rehabilitation program in athletes but we have carried out this prospective interventional study in Bangabandhu Sheikh Mujib Medical University (BSMMU) and our private settings from January 2007 to December 2011 to assess whether interferential screws provide any clinical and functional advantage in general population. Sixty six male patients of 21-40 years age, with ACL deficient knees were reconstructed with BPTB graft where 40 cases were augmented by interferential screws and 26 cases without and followed up for minimum 2 years. The clinical and functional outcome (by Lysholm Knee Scoring), post-operative knee stability (by clinical tests) and complications were assessed and recorded. There was significant (p<0.05, paired 't' test) improvement of knee function (limp, walking, stair climbing, squatting, thigh atrophy) in both groups but no significant difference between them (p>0.05, chi squared test) regarding clinical, functional outcome and knee stability. The complications were insignificant (p>0.05, chi squared test) in both groups but there were few cases of screw related complications with augmentation and pronounced anterior knee laxity without it. So, ACL reconstruction by BPTB grafts with or without augmentation results consistent and comparable outcome in general population. PMID:25725669

Arifeen, K N; Chowdhury, A Z; Sakeb, N; Joarder, A I; Salek, A K; Selimullah, A M

2015-01-01

22

Simultaneous anterior and posterior cruciate ligament reconstruction in chronic knee instabilities: surgical concepts and clinical outcome  

Microsoft Academic Search

The purpose of this study was to evaluate the clinical results of simultaneous arthroscopically assisted reconstruction of\\u000a anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) using autogenous tendon grafts in chronic knee injuries.\\u000a Nineteen patients (17 men and 2 women) with chronic multi-ligamentous injuries underwent one-stage ACL and PCL reconstruction.\\u000a ACL, PCL and medial collateral ligament were reconstructed in

Riku Hayashi; Nobuto Kitamura; Eiji Kondo; Yuko Anaguchi; Harukazu Tohyama; Kazunori Yasuda

2008-01-01

23

Skin dimpling as a complication of hamstring harvesting following anterior cruciate ligament reconstruction.  

PubMed

Surgical intervention to repair a torn anterior cruciate ligament (ACL) with autogenous hamstring tendons has become popular. However, hamstring graft harvesting complications can occur. This article presents a case of skin dimpling over the pes anserinus during active hamstring contraction in a 32-year-old man following arthroscopic ACL reconstruction. PMID:18686489

Tuncay, Ibrahim; Karalezli, Nazim

2008-07-01

24

Surgical Treatment of a Rare Isolated Bilateral Agenesis of Anterior and Posterior Cruciate Ligaments  

PubMed Central

The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow intercondylar notch. MRI brought to light a bilateral agenesis of both posterior cruciate ligaments. Arthroscopic evaluation confirmed bilateral isolated agenesis of both cruciate ligaments. We recommended a rehabilitation program to prepare the patient for the arthroscopic construction of both cruciate ligaments. PMID:25197599

2014-01-01

25

Outcomes of anterior cruciate ligament reconstruction in patients with workers' compensation claims  

Microsoft Academic Search

A general perception exists that outcomes of orthopaedic procedures in patient's with Worker's Compensation claims fare worse than those of patients without such claims. We retrospectively reviewed the outcomes of anterior cruciate ligament (ACL) reconstruction in patients who have Workers' Compensation claims. This minimum 2-year follow-up study analyzed the occupational, functional, and objective results of patients who underwent arthroscopic-assisted anterior

Gary Wexler; Bernard R. Bach; Charles A. Bush-Joseph; David Smink; James D. Ferrari; John Bojchuk

2000-01-01

26

Missed compartment syndrome after replacement of the anterior cruciate ligament following continuous epidural analgesia  

Microsoft Academic Search

Summary  \\u000a In this article we report a case of an early postoperative compartment syndrome of the anterior tibial compartment with complete\\u000a sensomotoric palsy of the peroneal nerve after arthroscopic-assisted replacement of the anterior cruciate ligament (ACL) of\\u000a the knee. The tourniquet pressure was 360 mm Hg and operation time was 1.75 h. After the operation the leg was bandaged to

F. Sorrentino; S. Eggli; U. Stricker; F. T. Ballmer; R. Hertel

1998-01-01

27

Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts.  

PubMed

A prospective study was performed on 30 patients who underwent an anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allograft. An arthroscopic technique alone was used in 10 patients, and in the other 20 patients this was combined with a miniarthrotomy. After a mean follow up of 35 months, the overall functional results were satisfactory in 85%. There were no cases of infection, disease transmission or tissue rejection. Fresh-frozen patellar tendon allografts are a good method of anterior cruciate reconstruction. PMID:8002109

Valenti, J R; Sala, D; Schweitzer, D

1994-01-01

28

Proprioception in anterior cruciate ligament deficient knees and its relevance in anterior cruciate ligament reconstruction  

PubMed Central

Injury to the anterior cruciate ligament (ACL) not only causes mechanical instability but also leads to a functional deficit in the form of diminished proprioception of the knee joint. “Functional” recovery is often incomplete even after “anatomic” arthroscopic ACL reconstruction, as some patients with a clinically satisfactory repair and good ligament tension continue to complain of a feeling of instability and giving way, although the knee does not sublux on clinical testing. Factors that may play a role could be proprioceptive elements, as the intact ACL has been shown to have significant receptors. Significant data have come to light demonstrating proprioceptive differences between normal and injured knees, and often between injured and reconstructed knees. ACL remnants have been shown to have proprioceptive fibers that could enhance functional recovery if they adhere to or grow into the reconstructed ligament. Conventionally the torn remnants are shaved off from the knee before graft insertion; modern surgical techniques, with remnant sparing methods have shown better outcomes and functional recovery, and this could be an avenue for future research and development. This article analyzes and reviews our understanding of the sensory element of ACL deficiency, with specific reference to proprioception as an important component of functional knee stability. The types of mechanoreceptors, their distribution and presence in ACL remnants is reviewed, and suggestions are made to minimize soft tissue shaving during ACL reconstruction to ensure a better functional outcome in the reconstructed knee. PMID:21772620

Dhillon, Mandeep S; Bali, Kamal; Prabhakar, Sharad

2011-01-01

29

Treatment of anterior cruciate ligament injuries, part 2.  

PubMed

Anterior cruciate ligament tears, common among athletes, are functionally disabling; they predispose the knee to subsequent injuries and the early onset of osteoarthritis. A total of 3810 studies published between January 1994 and the present were identified and reviewed to determine the current state of knowledge regarding the treatment of anterior cruciate ligament injuries. Part 1 of this article focused on studies pertaining to the biomechanical behavior of the anterior cruciate ligament, the prevalence of and risk factors for injuries related to it, the natural history of the ligament-deficient knee, injuries associated with anterior cruciate ligament disruption, indications for the treatment of anterior cruciate ligament injuries, as well as nonoperative and operative treatments. Part 2 includes technical aspects of anterior cruciate ligament surgery, bone tunnel widening, graft healing, rehabilitation after anterior cruciate ligament reconstruction, and the effects of sex, age, and activity level on the outcome of such reconstructive surgery. PMID:16230470

Beynnon, Bruce D; Johnson, Robert J; Abate, Joseph A; Fleming, Braden C; Nichols, Claude E

2005-11-01

30

Predisposing factors for anterior cruciate ligament injury  

Microsoft Academic Search

Lecture 5In sports, especially in football, one of the most common knee injuries is the anterior cruciate ligament (ACL) tear, which usually (70%) occurs through non-contact mechanisms that include; sudden deceleration, landing and pivoting manoeuvres which are repeatedly performed. Studies have shown that the incidence of ACL tear in female athletes is two to eight times higher than in men

Antonis Papoutsidakis

2011-01-01

31

Graft healing in anterior cruciate ligament reconstruction  

Microsoft Academic Search

Successful anterior cruciate ligament reconstruction with a tendon graft necessitates solid healing of the tendon graft in the bone tunnel. Improvement of graft healing to bone is crucial for facilitating an early and aggressive rehabilitation and ensuring rapid return to pre-injury levels activity. Tendon graft healing in a bone tunnel requires bone ingrowth into the tendon. Indirect Sharpey fiber formation

Chih-Hwa Chen

2009-01-01

32

Anterior cruciate ligament insufficiency: does delay in index surgery affect outcome in recreational athletes  

Microsoft Academic Search

The aim of the study was to see if delay in anterior cruciate ligament (ACL) reconstruction affects post-reconstruction outcome in recreational athletes. Sixty-two recreational athletes who had arthroscopic ACL reconstructions using quadruple hamstring grafts between 1997 and 2000 were retrospectively evaluated. Patients with less than 2 years’ follow-up, those with multi-ligament injuries, reconstructions for previous failed repairs, those whose injury date

A. D. Tambe; S. P. Godsiff; S. Mulay; M. Joshi

2006-01-01

33

Graft selection in anterior cruciate ligament reconstruction – prospective analysis of patellar tendon autografts compared with allografts  

Microsoft Academic Search

Summary. A prospective study of 73 arthroscopic anterior cruciate ligament reconstructions using either a patellar tendon autograft\\u000a or an allograft was made to assess any difference in clinical outcome. Allocation was by availability of an allograft. There\\u000a were 48 autografts and 25 allografts. Evaluation was by clinical examination and physical tests. At follow-up 2 years after\\u000a operation, there were no

J. Victor; J. Bellemans; E. Witvrouw; K. Govaers; G. Fabry

1997-01-01

34

Arthroscopic Anterior Shoulder Stabilization of Collision and Contact Athletes  

Microsoft Academic Search

Background:Repair of the anterior labrum (Bankart lesion) with tightening of the ligaments (capsulorrhaphy) is the recommended treatment for recurrent anterior glenohumeral dislocations. Current evidence suggests that arthroscopic anterior stabilization methods yield similar failure rates for resubluxation and redislocation when compared to open techniques.Study Design:Case series; Level of evidence, 4Purpose:To examine the results of arthroscopic anterior shoulder stabilization of high-demand collision

Augustus D. Mazzocca; Fred M. Brown; Dominic S. Carreira; Jennifer Hayden; Anthony A. Romeo

2005-01-01

35

[Anterior cruciate ligament injuries in children].  

PubMed

An increasing number of anterior cruciate ligament injuries are now seen in children and girls seem to be equally affected. Such neglected or untreated lesions could be the cause of early degenerative changes. Recently, many authors support the trend toward early surgical management in skeletally immature patients with complex meniscal tear or recurrent knee instability after proper rehabilitation. Improvement in pediatric knowledge and surgical techniques tend to support a tendency for more surgical treatment in children. The type of management is choosing according to history and physical examination. Magnetic resonance imaging is a useful tool not only for diagnosis but also for surgical treatment planning. We usually recommend anterior cruciate ligament reconstruction in children with knee instability or with further damages to the joint. PMID:23971325

Tercier, S; Zambelli, P-Y

2013-07-17

36

Imaging of the anterior cruciate ligament  

PubMed Central

The anterior cruciate ligament (ACL) is an important structure in maintaining the normal biomechanics of the knee and is the most commonly injured knee ligament. However, the oblique course of the ACL within the intercondylar fossa limits the visualization and assessment of the pathology of the ligament. This pictorial essay provides a comprehensive and illustrative review of the anatomy and biomechanics as well as updated information on different modalities of radiological investigation of ACL, particularly magnetic resonance imaging. PMID:22474639

Ng, Wing Hung Alex; Griffith, James Francis; Hung, Esther Hiu Yee; Paunipagar, Bhawan; Law, Billy Kan Yip; Yung, Patrick Shu Hang

2011-01-01

37

Surgical Management of Anterior Cruciate Ligament Injuries  

Microsoft Academic Search

An anterior cruciate ligament (ACL) injury produces an athletic disability that is the most common knee injury to require\\u000a a ligament reconstruction. Recent research has contributed to a better understanding of all aspects of this injury, but it\\u000a is particularly in the areas of kinematics, graft placement, and graft fixation that the greatest improvements have occurred.\\u000a Controversy abounds in the

Mark E. Steiner

38

Graft healing in anterior cruciate ligament reconstruction  

Microsoft Academic Search

Graft healing within the bone tunnel after anterior cruciate ligament (ACL) reconstruction is still a complex, poorly understood\\u000a biological process that is influenced by multiple surgical and postoperative variables. However, remarkable advances in knowledge\\u000a of this process have been made based primarly on animal models. According to the findings of this review, some surgical and\\u000a postoperative variables are known to

Max Ekdahl; James H.-C. Wang; Mario Ronga; Freddie H. Fu

2008-01-01

39

Mucoid degeneration of the anterior cruciate ligament  

Microsoft Academic Search

Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. We report a case of a patient with\\u000a mucoid degeneration of the ACL, presenting with posterior knee pain and no history of a major knee trauma. On clinical examination,\\u000a the active range of motion showed a flexion deficit. The posterior knee pain was induced by

Robrecht Motmans; Frank Verheyden

2009-01-01

40

Anatomic anterior cruciate ligament reconstruction: a changing paradigm.  

PubMed

Injury to the anterior cruciate ligament (ACL) of the knee is potentially devastating for the patient and can result in both acute and long-term clinical problems. Consequently, the ACL has always been and continues to be of great interest to orthopaedic scientists and clinicians worldwide. Major advancements in ACL surgery have been made in the past few years. ACL reconstruction has shifted from an open to arthroscopic procedure, in which a two- and later one-incision technique was applied. Studies have found that traditional, transtibial arthroscopic single-bundle reconstruction does not fully restore rotational stability of the knee joint, and as such, a more anatomic approach to ACL reconstruction has emerged. The goal of anatomic ACL reconstruction is to replicate the knee's normal anatomy and restore its normal kinematics, all while protecting long-term knee health. This manuscript describes the research that has changed the paradigm of ACL reconstruction from traditional techniques to present day anatomic and individualized concepts. PMID:25086574

Fu, Freddie H; van Eck, Carola F; Tashman, Scott; Irrgang, James J; Moreland, Morey S

2015-03-01

41

Congenital absence of the anterior cruciate ligament in monozygotic twins.  

PubMed

Cases of congenital absence of the cruciate ligaments are seen rarely in the literature. When reported, they are almost exclusively associated with various additional lower extremity deformities. We report the cases of 15-year-old monozygotic twin brothers. Both brothers presented with right knee pain and instability and were found on magnetic resonance imaging (MRI) to have congenital absence of the right anterior cruciate ligament (ACL). Examination of full length leg radiographs and MRI of the knee showed no associated abnormalities. Twin B previously underwent partial medial meniscectomy performed by an outside orthopaedic surgeon at which time the absence of the ACL was noted but not repaired. After diagnosis at our practice, both twins underwent arthroscopically assisted ACL construction with bone-patella-bone-autograft. Following recovery from surgery, both twins returned to high level athletics. These cases are among few reports of isolated congenital absence of the ACL, and to our knowledge there are no other cases of isolated congenital absence of the ACL in monozygotic twins. PMID:25203652

Sonn, K A; Caltoum, C B

2014-12-01

42

Arthroscopic Capsulolabral Revision Repair for Recurrent Anterior Shoulder Instability  

Microsoft Academic Search

Background: Open capsulolabral repair is still considered the standard revision procedure for a failed anterior shoulder instability repair. To date, only a few studies have evaluated the outcome of arthroscopic revision instability repair.Purpose: This study was undertaken to assess the clinical outcome and postoperative sports activity level of arthroscopic revision stabilization using defined inclusion criteria and a standardized operative revision

Christoph Bartl; Katrin Schumann; Jochen Paul; Stephan Vogt; Andreas B. Imhoff

2011-01-01

43

Proprioception in Anterior Cruciate Ligament-Deficient and Reconstructed Knees  

Microsoft Academic Search

Proprioceptive function of the knee was quantified and compared in three groups of patients: those with ante rior cruciate ligament deficiency, with hamstring ten dons-ligament augmentation device anterior cruciate ligament reconstructions, and with bone-patellar ten don-bone anterior cruciate ligament reconstructions. A total of 32 subjects, including 6 uninjured control sub jects, were tested for threshold to perception of passive motion

Peter B. MacDonald; David Hedden; Ondrej Pacin; Kelly Sutherland

1996-01-01

44

Outpatient Surgical Management of Arthrofibrosis After Anterior Cruciate Ligament Surgery  

Microsoft Academic Search

We present a consecutive series of nine patients who were referred to us because of arthrofibrosis (loss of >15° of extension) after intraarticular anterior cruciate ligament reconstruction using autogenous patellar ten don (eight patients) or semitendinosus (one patient) graft. Eight patients had surgery within 2 weeks of injury. All patients had been immobilized in flexion after the anterior cruciate ligament

K. Donald Shelbourne; Glen E. Johnson

1994-01-01

45

Anterior Cruciate Ligament Strain Behavior During Rehabilitation Exercises In Vivo  

Microsoft Academic Search

Before studying the biomechanical effects of rehabili tation exercises on the reconstructed knee, it is impor tant to understand their effects on the normal anterior cruciate ligament. The objective of this investigation was to measure the strain behavior of this ligament dur ing rehabilitation activities in vivo. Participants were pa tient volunteers with normal anterior cruciate ligaments instrumented with the

Bruce D. Beynnon; Braden C. Fleming; Robert J. Johnson; Claude E. Nichols; Per A. Renström; Malcolm H. Pope

1995-01-01

46

Treatment of anterior cruciate ligament injuries, part I.  

PubMed

Anterior cruciate ligament injuries are common among athletes. Although the true natural history remains unclear, anterior cruciate ligament injuries are functionally disabling; they predispose the knee to subsequent injuries and the early onset of osteoarthritis. This article, the first in a 2-part series, was initiated with the use of the PubMed database and a comprehensive search of articles that appeared between January 1994 to the present, using the keywords anterior cruciate ligament. A total of 3810 citations were identified and reviewed to determine the current state of knowledge about the treatment of these injuries. Articles pertaining to the biomechanical behavior of the anterior cruciate ligament, the prevalence of anterior cruciate ligament injury, the natural history of the anterior cruciate ligament-deficient knee, injuries associated with anterior cruciate ligament disruption, risk factors for anterior cruciate ligament injury, indications for treatment of anterior cruciate ligament injuries, and nonoperative and operative treatments were obtained, reviewed, and served as the basis for part I. Part II, to be presented in another issue of this journal, includes technical aspects of anterior cruciate ligament surgery, bone tunnel widening, graft healing, rehabilitation after reconstruction, and the effect of sex, age, and activity level on the outcome of surgery. Our approach was to build on prior reviews and to provide an overview of the literature for each of the before-mentioned areas of study by summarizing the highest level of scientific evidence available. For the areas that required a descriptive approach to research, we focused on the prospective studies that were available; for the areas that required an experimental approach, we focused on the prospective, randomized controlled trials and, when necessary, the highest level of evidence available. We were surprised to learn that considerable advances have been made during the past decade regarding the treatment of this devastating injury. PMID:16199611

Beynnon, Bruce D; Johnson, Robert J; Abate, Joseph A; Fleming, Braden C; Nichols, Claude E

2005-10-01

47

Anterior cruciate ligament reconstruction in patients older than 35 years.  

PubMed

Anterior cruciate ligament (ACL) reconstruction is an increasingly established method even in patients older than 35 years. Our hypothesis is that functional outcome after ACL reconstruction is comparable in patients younger and older than 35 years. A total of 28 patients (5 women and 23 men) with average age of 41.5 years (36-68) were retrospectively evaluated. The average follow-up period was 33 months. All of them were treated operatively with arthroscopic single-bundle four-strand hamstring tendon autograft. The functional outcome was determined by clinical scores (Tegner activity scale and Lysholm knee score). The median values for the Lysholm knee score were preoperatively 77 and postoperatively 96 points (range, 90-100) with significant improvement (p?anterior knee instability. We commonly propose surgical treatment in symptomatic patients who express the need to restore their preinjury activity levels, regardless of their age. PMID:24510521

El-Sallakh, Sameh; Pastides, Philip; Thomas, Panos

2014-12-01

48

Current Trends in Anterior Cruciate Ligament ReconstructionPart II. Operative Procedures and Clinical Correlations  

Microsoft Academic Search

Surgical management of the anterior cruciate ligament-deficient knee has evolved from primary repair to extracapsular augmentation to anterior cruciate ligament reconstruction using biologic tissue grafts. The technique of anterior cruciate ligament reconstruction has improved over the last few decades with the aid of knowledge gained from basic science and clinical research. The biology and biomechanics of anterior cruciate ligament reconstruction

Freddie H. Fu; Craig H. Bennett; C. Benjamin Ma; Jacques Menetrey; Christian Lattermann

2000-01-01

49

Risk Factors for Anterior Cruciate Ligament Injury  

PubMed Central

Context: Injuries to the anterior cruciate ligament (ACL) are immediately disabling and are associated with long-term consequences, such as posttraumatic osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 2 of a 2-part series, highlights what is known and still unknown regarding hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors for ACL injury. Data Sources: Studies were identified from MEDLINE (1951–March 2011) using the MeSH terms anterior cruciate ligament, knee injury, and risk factors. The bibliographies of relevant articles and reviews were cross-referenced to complete the search. Study Selection: Prognostic case-control and prospective cohort study designs to evaluate risk factors for ACL injury were included in this review. Results: A total of 50 case-control and prospective cohort articles were included in parts 1 and 2. Twenty-one focused on hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors. Conclusions: Several risk factors are associated with increased risk of suffering ACL injury—such as female sex, prior reconstruction of the ACL, and familial predisposition. These risk factors most likely act in combination with the anatomic factors reviewed in part 1 of this series to influence the risk of suffering ACL injury. PMID:23016083

Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra; Beynnon, Bruce D.

2012-01-01

50

Risk of Tearing the Intact Anterior Cruciate Ligament in the Contralateral Knee and Rupturing the Anterior Cruciate Ligament Graft During the First 2 Years After Anterior Cruciate Ligament ReconstructionA Prospective MOON Cohort Study  

Microsoft Academic Search

Background: The risk of tear of the intact anterior cruciate ligament in the contralateral knee after anterior cruciate ligament reconstruction of the opposite knee and the incidence of rupturing the anterior cruciate ligament graft during the first 2 years after surgery have not been extensively studied in a prospective manner. Clinicians have hypothesized that the opposite normal knee is at

Rick W. Wright; Warren R. Dunn; Annunziato Amendola; Jack T. Andrish; John Bergfeld; Christopher C. Kaeding; Robert G. Marx; Eric C. McCarty; Richard D. Parker; Michelle Wolcott; Brian R. Wolf; Kurt P. Spindler

2007-01-01

51

Complications of anterior cruciate ligament reconstruction: MR imaging.  

PubMed

Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is being performed with increasing frequency, particularly in young athletes. Although the procedure is generally well tolerated, with good success rates, early and late complications have been documented. As clinical manifestations of graft complications are often non-specific and plain radiographs cannot directly visualize the graft and the adjacent soft tissues, MR imaging has a definite role in the diagnosis of complications after ACL reconstruction and may direct subsequent therapeutic management. Our purpose is to review the normal MR imaging of the ACL graft and present the MR imaging findings of a wide spectrum of complications after ACL reconstruction, such as graft impingement, graft rupture, cystic degeneration of the graft, postoperative infection of the knee, diffuse and localized (i.e., cyclops lesion) arthrofibrosis, and associated donor site abnormalities. Awareness of the MR imaging findings of complications as well as the normal appearances of the normal ACL graft is essential for correct interpretation. PMID:12695835

Papakonstantinou, Olympia; Chung, Christine B; Chanchairujira, Kullanuch; Resnick, Donald L

2003-05-01

52

Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis?  

Microsoft Academic Search

Purpose  To determine the usefulness of magnetic resonance (MR) imaging to distinguish stable from unstable tears of the anterior cruciate\\u000a ligament (ACL) of the knee.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  MR images of 97 patients with surgically confirmed ACL tear were retrospectively reviewed. According to arthroscopic and clinical\\u000a examination, these patients had 36 stable and 61 unstable (9 partial and 52 complete) ACL tears.

Pieter Van Dyck; Jan L. Gielen; Filip M. Vanhoenacker; Kristien Wouters; Lieven Dossche; Paul M. Parizel

53

Anterior cruciate ligament reconstruction with BPTB autograft, irradiated versus non-irradiated allograft: a prospective randomized clinical study  

Microsoft Academic Search

The effect of using gamma irradiation to sterilize bone-patellar tendon-bone (BPTB) allograft on the clinical outcomes of\\u000a anterior cruciate ligament (ACL) reconstruction with irradiated allograft remains controversial. Our study was aimed to analyze\\u000a the clinical outcomes of arthroscopic ACL reconstruction with irradiated BPTB allograft compared with non-irradiated allograft\\u000a and autograft. All BPTB allografts were obtained from a single tissue bank

Kang Sun; Shaoqi Tian; Jihua Zhang; Changsuo Xia; Cailong Zhang; Tengbo Yu

2009-01-01

54

Effects of Initial Graft Tension on Clinical Outcome After Anterior Cruciate Ligament ReconstructionAutogenous Doubled Hamstring Tendons Connected in Series with Polyester Tapes  

Microsoft Academic Search

We conducted a prospective, randomized, short-term study to clarify the effects of initial graft tension on clinical outcome after arthroscopically assisted anterior cruciate ligament reconstruction with autogenous dou bled semitendinosus and gracilis tendons connected in series with polyester tapes. Seventy Japanese patients with chronic, \\

Kazunori Yasuda; Jun Tsujino; Yoshie Tanabe; Kiyoshi Kaneda

1997-01-01

55

Individualized anatomic anterior cruciate ligament reconstruction.  

PubMed

Abstract Anterior cruciate ligament (ACL) injuries are often seen in young participants in sports such as soccer, football, and basketball. Treatment options include conservative management as well as surgical intervention, with the goal of enabling the patient to return to cutting and pivoting sports and activities. Individualized anatomic ACL reconstruction is a surgical technique that tailors the procedure to the individual patient using preoperative measurements on plain radiographs and magnetic resonance imaging and intraoperative measurement to map the patients' native ACL anatomy in order to replicate it as closely as possible. Anatomic ACL reconstruction, therefore, is defined as reconstruction of the ACL to its native dimensions, collagen orientation, and insertion site. The surgical reconstruction is followed by a specific rehabilitation protocol that is designed to enable the patient to regain muscle strength and proprioception while facilitating healing of the reconstructed ACL prior to the patient's returning to sports activities. PMID:25684559

van Eck, Carola F; Widhalm, Harrald; Murawski, Christopher; Fu, Freddie H

2015-02-01

56

Current Trends in Anterior Cruciate Ligament Reconstruction  

PubMed Central

The advances in the knowledge of anatomy, surgical techniques, and fixation devices have led to the improvement of anterior cruciate ligament (ACL) reconstruction over the past 10 years. Nowadays, double bundle and anatomical single bundle ACL reconstruction that more closely restores the normal anatomy of the ACL are becoming popular. Although there is still no definite conclusion whether double bundle ACL reconstruction provides better clinical results than single bundle reconstruction, the trend has shifted to anatomic reconstruction regardless of single bundle or double bundle techniques. We could not find any significant differences in the clinical outcomes and stability after ACL reconstruction according to the type of graft or fixation device. Therefore, surgeons should select an ideal ACL reconstruction according to the patient's condition and surgeon's experience. PMID:24368993

Kim, Ha Sung; Jo, Ah Reum

2013-01-01

57

Infections in Anterior Cruciate Ligament Reconstruction  

PubMed Central

Context: Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome. Evidence Acquisition: Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters. Results: Treatment with culture-specific antibiotics and debridement with graft retention is recommended as initial treatment, but with persistent infection, consideration should be given to graft removal. Graft type likely has no effect on infection rates. Conclusion: The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis. PMID:24427432

Stucken, Charlton; Garras, David N.; Shaner, Julie L.; Cohen, Steven B.

2013-01-01

58

Graft healing in anterior cruciate ligament reconstruction.  

PubMed

Successful anterior cruciate ligament reconstruction with a tendon graft necessitates solid healing of the tendon graft in the bone tunnel. Improvement of graft healing to bone is crucial for facilitating an early and aggressive rehabilitation and ensuring rapid return to pre-injury levels activity. Tendon graft healing in a bone tunnel requires bone ingrowth into the tendon. Indirect Sharpey fiber formation and direct fibrocartilage fixation confer different anchorage strength and interface properties at the tendon-bone interface. For enhancing tendon graft-to-bone healing, we introduce a strategy that includes the use of periosteum, hydrogel supplemented with periosteal progenitor cells and bone morphogenetic protein-2, and a periosteal progenitor cell sheet. Future studies include the use of cytokines, gene therapy, stem cells, platelet-rich plasma, and mechanical stress for tendon-to-bone healing. These strategies are currently under investigation, and will be applied in the clinical setting in the near future. PMID:19772670

Chen, Chih-Hwa

2009-01-01

59

Design of a novel anterior cruciate ligament prosthesis  

E-print Network

Injuries to the anterior cruciate ligament (ACL) are extremely common (approximately 100,000 every year in the US) and result in greatly reduced mobility; although several surgical procedures have been devised to address ...

Talei Franzesi, Giovanni

2006-01-01

60

The 5-Strand Hamstring Graft in Anterior Cruciate Ligament Reconstruction  

PubMed Central

The use of anterior cruciate ligament reconstruction in the pediatric and adolescent population has been increasing in recent years. Autograft hamstring graft is favored in this population, but these patients often have smaller hamstring tendons that yield smaller final graft constructs. These smaller grafts are associated with an increased need for revision surgery. We describe a technique for obtaining a larger-diameter anterior cruciate ligament graft construct from autologous hamstring graft without allograft supplementation. PMID:25473619

Lee, Rushyuan Jay; Ganley, Theodore J.

2014-01-01

61

The 5-strand hamstring graft in anterior cruciate ligament reconstruction.  

PubMed

The use of anterior cruciate ligament reconstruction in the pediatric and adolescent population has been increasing in recent years. Autograft hamstring graft is favored in this population, but these patients often have smaller hamstring tendons that yield smaller final graft constructs. These smaller grafts are associated with an increased need for revision surgery. We describe a technique for obtaining a larger-diameter anterior cruciate ligament graft construct from autologous hamstring graft without allograft supplementation. PMID:25473619

Lee, Rushyuan Jay; Ganley, Theodore J

2014-10-01

62

Graft selection in anterior cruciate ligament reconstruction.  

PubMed

The ideal graft for use in anterior cruciate ligament reconstruction should have structural and biomechanical properties similar to those of the native ligament, permit secure fixation and rapid biologic incorporation, and limit donor site morbidity. Many options have been clinically successful, but the ideal graft remains controversial. Graft choice depends on surgeon experience and preference, tissue availability, patient activity level, comorbidities, prior surgery, and patient preference. Patellar tendon autograft, the most widely used graft source, appears to be associated with an increased incidence of anterior knee pain compared with hamstring autograft. Use of hamstring autograft is increasing. Quadriceps tendon autograft is less popular but has shown excellent clinical results with low morbidity. Improved sterilization techniques have led to increased safety and availability of allograft, although allografts have a slower rate of incorporation than do most types of autograft. No graft has clearly been shown to provide a faster return to play. However, in general, patellar tendon autografts are preferable for high-performance athletes, and hamstring autografts and allografts have some relative advantages for lower-demand individuals. No current indications exist for synthetic ligaments. PMID:15938608

West, Robin V; Harner, Christopher D

2005-01-01

63

Arthroscopic anterior cruciate ligament surgery: results of autogenous patellar tendon graft versus the Leeds-Keio synthetic graft five year follow-up of a prospective randomised controlled trial.  

PubMed

We conducted a prospective, randomised controlled trial comparing anterior cruciate ligament reconstruction using middle third patellar tendon graft (PT) to synthetic Leeds-Keio (LK) ligament. The patients were randomised (26 PT, 24 LK). Subjective knee function was classified (Lysholm, Tegner activity, IKDC scores), laxity was measured (Lachman test, Stryker laxometer), and functional ability was assessed (one-hop test). There were no significant differences between Lysholm or IKDC scores at any stage by 5 years. Significant differences were found between the groups at 2 years for Tegner activity scores, laxity and one-hop testing. By 5 years there were no significant differences. Clinical equivalence was demonstrated between the two groups for the Lysholm score and one-hop test but not for the Tegner activity score at 5 years. The use of the LK ligament has been largely abandoned due to reports of its insufficiency. Our results demonstrate that it is not as inferior as one might expect. We conclude that the results of LK ligament ACL reconstruction are as acceptable as those using PT. It may provide an additional means of reconstruction where no suitable alternative is present. PMID:19861236

Ghalayini, S R A; Helm, A T; Bonshahi, A Y; Lavender, A; Johnson, D S; Smith, R B

2010-10-01

64

Anterior cruciate ligament surgery in the rabbit  

PubMed Central

Background Various methods regarding allograft knee replacements have been described. The animal models, which are generally used for this purpose include sheep, dogs, goats, and pigs, and accrue significant costs for study protocols. The authors herein describe an efficient and cost-effective model to study either native or tissue-engineered allografts for anterior cruciate ligament (ACL) replacement in a New Zealand rabbit model with the potential for transgenic and cell migration studies. Methods ACL reconstructions were performed in rabbits under general anesthesia. For fresh allograft implantations, two animals were operated in parallel. Each right extensor digitorum longus tendon was harvested and prepared for implantation. After excision of the ACL, tibial and femoral bone tunnels were created to implant each graft in the native ACL position. Results During a 2-year period, the authors have successfully undertaken this surgery in 61 rabbits and have not noticed any major complications attributed to this surgical technique. In addition, the authors have observed fast recovery in the animals postoperatively. Conclusion The authors recommend this surgical procedure as an excellent model for the study of knee surgery. PMID:23957941

2013-01-01

65

Principles of postoperative anterior cruciate ligament rehabilitation  

PubMed Central

It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, “ossified” knowledge or modalities really prove themselves in the literature? Could questions such as “is postoperative brace use really necessary?”, “what are the benefits of early restoration of the range of motion (ROM)?”, “to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?”, “how early can proprioception training and open chain exercises begin?”, “should strengthening training start in the immediate postoperative period?” be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521

Saka, Tolga

2014-01-01

66

Guideline on anterior cruciate ligament injury  

PubMed Central

The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steering group of the Dutch Orthopaedic Association. What is the role of physical examination and additional diagnostic tools? Which patient-related outcome measures should be used? What are the relevant parameters that influence the indication for an ACL reconstruction? Which findings or complaints are predictive of a bad result of an ACL injury treatment? What is the optimal timing for surgery for an ACL injury? What is the outcome of different conservative treatment modalities? Which kind of graft gives the best result in an ACL reconstruction? What is the optimal postoperative treatment concerning rehabilitation, resumption of sports, and physiotherapy? These 8 questions were answered and recommendations were made, using the “Appraisal of Guidelines for Research and Evaluation” instrument. This instrument seeks to improve the quality and effectiveness of clinical practical guidelines by establishing a shared framework to develop, report, and assess. The steering group has also developed 7 internal indicators to aid in measuring and enhancing the quality of the treatment of patients with an ACL injury, for use in a hospital or practice. PMID:22900914

2012-01-01

67

Graft healing in anterior cruciate ligament reconstruction.  

PubMed

Graft healing within the bone tunnel after anterior cruciate ligament (ACL) reconstruction is still a complex, poorly understood biological process that is influenced by multiple surgical and postoperative variables. However, remarkable advances in knowledge of this process have been made based primarly on animal models. According to the findings of this review, some surgical and postoperative variables are known to directly affect time-course and quality of graft-tunnel healing. The type of graft, graft motion, and fixation methods have shown to directly affect time-course and quality of graft-tunnel healing. Therefore, the application of early and aggressive rehabilitation protocols should be cautious when using soft-tissue graft, allografts, and direct or aperture type of fixation for ACL reconstruction. With regard to graft placement, several cadaveric models showed biomechanical advantages of a more anatomical graft location; however, there are no studies that explore the relationship between graft placement and healing process. The precise effect of graft tensioning, graft/tunnel diameter disparity, and graft length within the bone tunnel in the graft healing process remains unclear and requires more research. To enhance graft-tunnel healing, tissue-engineering approaches, including the use of growth factors, mesenchymal stem cells, and periosteum graft augmentation, have been tested on animal models. These have shown promising results in terms of enhancement of bone-graft healing rate. PMID:18633596

Ekdahl, Max; Wang, James H-C; Ronga, Mario; Fu, Freddie H

2008-10-01

68

Evaluation of the Single-Incision Arthroscopic Technique for Anterior  

E-print Network

A Study of Tibial Tunnel Placement, Intraoperative Graft Tension, and Stability Stephen M. Howell,* LTC tensile behavior of the double-looped semitendinosus and gracilis tendon graft can be normal or abnormal compared with the native anterior cruciate ligament, that the placement and angle of the tibial tunnel can

Hull, Maury

69

Current Trends in Anterior Cruciate Ligament ReconstructionPart 1: Biology and Biomechanics of Reconstruction  

Microsoft Academic Search

With today's increasing emphasis on sporting activities, the incidence of anterior cruciate ligament injuries has also increased. Epidemiologic studies estimate that the prevalence of anterior cruciate ligament injuries is about 1 per 3000 Americans. Management of these injuries has evolved from nonoperative treatment to extracapsular augmentation and primary ligament repair to anterior cruciate ligament reconstruction. Treatment of these injuries has

Freddie H. Fu; Craig H. Bennett; Christian Lattermann; C. Benjamin Ma

1999-01-01

70

Compartment syndrome with mononeuropathies after anterior cruciate ligament reconstruction.  

PubMed

Compartment syndrome rarely follows anterior cruciate ligament reconstruction. However, when it does, it may result in mononeuropathies that are amenable to neurolysis. The authors of this study present an 18-yr-old woman who sustained a right anterior cruciate ligament tear and underwent uneventful anterior cruciate ligament reconstruction using femoral and popliteal nerve blocks. Postoperatively, she developed compartment syndrome requiring emergent fasciotomies. At 11 wks after fasciotomy, results of electrophysiologic tests showed evidence of severe fibular and tibial neuropathies. Magnetic resonance images showed extensive tricompartmental myonecrosis. Fibular and tibial neurolysis as well as decompression were performed, followed by intensive outpatient rehabilitation. At the 6-mo follow-up, she reported resolution of pain as well as significant improvement in sensation, strength, and function. Early recognition and intervention are crucial to prevent serious neurologic damage. Excessive tourniquet pressure and anesthetic nerve blocks may have been responsible. PMID:25802956

J Kindle, Brett; Murthy, Naveen; Stolp, Kathryn

2015-05-01

71

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using In Situ Hamstring Graft With 4 Tunnels  

PubMed Central

A careful review of the literature suggests that a significant number of patients undergoing anterior cruciate ligament (ACL) reconstruction have less-than-optimal results. Although overall outcomes of ACL reconstruction are favorable, there remains considerable room for improvement. Anatomically, the ACL consists of 2 major functional bundles, the anteromedial bundle and the posterolateral bundle. Biomechanically, both bundles contribute significantly to the anterior and rotational stability of the knee. Therefore anatomic double-bundle ACL reconstruction techniques may further improve the outcomes in ACL surgery. This article presents a technique for arthroscopic double-bundle ACL reconstruction that includes the use of 2 femoral and 2 tibial tunnels to restore both the anteromedial and posterolateral bundles of the ACL with minimal hardware for fixation. PMID:24749023

Wagih, Ahmad M.

2013-01-01

72

Allograft Versus Autograft Anterior Cruciate Ligament Reconstruction  

PubMed Central

Background: Tearing an anterior cruciate ligament (ACL) graft is a devastating occurrence after ACL reconstruction (ACLR). Identifying and understanding the independent predictors of ACLR graft failure is important for surgical planning, patient counseling, and efforts to decrease the risk of graft failure. Hypothesis: Patient and surgical variables will predict graft failure after ACLR. Study Design: Prospective cohort study. Methods: A multicenter group initiated a cohort study in 2002 to identify predictors of ACLR outcomes, including graft failure. First, to control for confounders, a single surgeon’s data (n = 281 ACLRs) were used to develop a multivariable regression model for ACLR graft failure. Evaluated variables were graft type (autograft vs allograft), sex, age, body mass index, activity at index injury, presence of a meniscus tear, and primary versus revision reconstruction. Second, the model was validated with the rest of the multicenter study’s data (n = 645 ACLRs) to evaluate the generalizability of the model. Results: Patient age and ACL graft type were significant predictors of graft failure for all study surgeons. Patients in the age group of 10 to 19 years had the highest percentage of graft failures. The odds of graft rupture with an allograft reconstruction are 4 times higher than those of autograft reconstructions. For each 10-year decrease in age, the odds of graft rupture increase 2.3 times. Conclusion: There is an increased risk of ACL graft rupture in patients who have undergone allograft reconstruction. Younger patients also have an increased risk of ACL graft failure. Clinical Relevance: Given these risks for ACL graft rupture, allograft ACLRs should be performed with caution in the younger patient population. PMID:23015994

Kaeding, Christopher C.; Aros, Brian; Pedroza, Angela; Pifel, Eric; Amendola, Annunziato; Andrish, Jack T.; Dunn, Warren R.; Marx, Robert G.; McCarty, Eric C.; Parker, Richard D.; Wright, Rick W.; Spindler, Kurt P.

2011-01-01

73

Anterior Cruciate Ligament Injuries in Wakeboarding  

PubMed Central

Background: Wakeboarding is an increasingly popular sport that involves aggressive stunts with high risk for lower extremity injury, including anterior cruciate ligament (ACL) rupture. Little has been reported on prevalence or mechanism of ACL injury while wakeboarding. Hypothesis: The prevalence of ACL injury in wakeboarding approaches that of other high-risk sports. Analyzing the mechanism of ACL injury may aid in future efforts of prevention. Study Design: Descriptive epidemiology study. Methods: In sum, 1580 surveys were sent internationally to professional and amateur wakeboarders. The survey questioned the participants on their history of an ACL tear while wakeboarding and asked them to describe the mechanism of injury and treatment. Results: A total of 123 surveys were returned. Of this group, 52 (42.3%) acknowledged having had an ACL tear while wakeboarding. The majority described feeling a pop or buckle after attempting to land a high jump. Only 5 participants (13.5%) described a rotational mechanism created by catching the board edge in the water. Thirty-seven participants (71.15%) said that the injury ruined their ability to wakeboard before reconstruction, and 41 (78.85%) had the injury repaired surgically. Conclusion: The prevalence of ACL tears in this data set, 42.3%, is the highest reported in the literature for wakeboarding and one of the highest for any sport. The main mechanism of injury appears to involve axial compression while one lands in a provocative position; it is not related to a rotational force created by fixed bindings. The injury should be surgically repaired to effectively continue the sport. Further study is needed to determine if wakeboarding represents a high-risk sport for ACL injury. Clinical Significance: Wakeboarding may be a high-risk sport for ACL injury. Noncontact axial compression appears to be the main mechanism of injury. PMID:23016104

Starr, Harlan M.; Sanders, Brett

2012-01-01

74

Anterior Cruciate Ligament Injury in Female Athletes: Epidemiology  

PubMed Central

Objective: To present epidemiologic studies on anterior cruciate ligament (ACL) injuries in female athletes. Data Sources: MEDLINE was searched from 1978 to 1998 with the terms “anterior cruciate ligament” and “female athlete” among others. Additional sources were knowledge base and oral, didactic, and video presentations. Data Synthesis: Epidemiologic studies have focused on level of participation, specific sports, sex differences and contributing factors, injury mechanism, prevention programs, and outcomes studies. Female athletes have a significantly increased risk of noncontact ACL injuries over male athletes in soccer and basketball. Conclusions/Recommendations: I believe that appropriate intervention programs can reduce these alarming rates of ACL injuries. ImagesFigure 2.Figure 3. PMID:16558558

Ireland, Mary Lloyd

1999-01-01

75

A symptomatic cyclops lesion 4 years after anterior cruciate ligament reconstruction.  

PubMed

The cyclops lesion is a fibrous nodule with central granulation tissue located anterolateral to the tibial tunnel after intra-articular reconstruction of the anterior cruciate ligament (ACL) that has been shown to be a cause of failure to regain full extension in the early postoperative period. We present the case of a 23-year-old woman who had undergone arthroscopic ACL reconstruction with a patellar tendon autograft 4 years prior to presentation. Following her reconstruction, she regained full range of motion and returned to collegiate cheerleading. At presentation, she complained of a gradual loss of full extension and joint-line pain with terminal extension. On examination, her graft was stable and she lacked 3 degrees of extension. Magnetic resonance imaging documented a 1-cm mass of low signal intensity immediately anterior to the ACL graft within the intercondylar notch. At arthroscopy, a large amount of thick, immobile scar tissue was found immediately anterior to the ACL, consistent with a cyclops lesion. The lesion was debrided and the patient did well postoperatively. Patients who present with delayed-onset loss of extension after ACL reconstruction should undergo careful evaluation including radiographs and magnetic resonance imaging. If a cyclops lesion is diagnosed, arthroscopic resection should be undertaken. PMID:11172260

Nuccion, S L; Hame, S L

2001-02-01

76

Achieving Full Range Of Motion After Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

A review of 119 consecutive anterior cruciate ligament reconstructions showed that the time from injury to surgery (early versus delayed) did not make a differ ence in obtaining full range of motion. Only patients with late surgery had a slight decrease in range of motion. Followup data were obtained for 111 recon structions. Twenty-one were early surgeries (1 to 14

Roy A. Majors; Blane Woodfin

1996-01-01

77

Success of Meniscal Repair at Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background: Meniscal repair is performed in an attempt to prevent posttraumatic arthritis resulting from meniscal dysfunction after meniscal tears. The socioeconomic implications of premature arthritis are significant in the young patient population. Investigations and techniques focusing on meniscus preservation and healing are now at the forefront of orthopaedic sports medicine.Hypothesis: Concomitant meniscal repair with anterior cruciate ligament reconstruction is a

Charles V. Toman; Warren R. Dunn; Kurt P. Spindler; Annunziata Amendola; Jack T. Andrish; John A. Bergfeld; David Flanigan; Morgan H. Jones; Christopher C. Kaeding; Robert G. Marx; Matthew J. Matava; Eric C. McCarty; Richard D. Parker; Michelle Wolcott; Armando Vidal; Brian R. Wolf; Laura J. Huston; Frank E. Harrell; Rick W. Wright

2009-01-01

78

Knee rehabilitation after anterior cruciate ligament reconstruction and repair  

Microsoft Academic Search

The purpose of this paper is to present the specifics and rationale of our postoperative rehabilitation pro gram after anterior cruciate ligament (ACL) recon struction and compare it with an international survey of 50 knee experts. It is important to stress that what we present is opinion. This opinion, however, is based on principles, guidelines, and specifics which we be

Lonnie Paulos; Frank R. Noyes; Edward Grood; David L. Butler

1981-01-01

79

The biomechanics of anterior cruciate ligament rehabilitation and reconstruction  

Microsoft Academic Search

The rehabilitation of knee injuries involving the anterior cruciate ligament (ACL) is controversial. This paper describes strain in the normal and reconstructed ACL during a series of passive and active tests of knee flexion with and without varus, valgus, and axial rotation torques on the tibia. Strain in the human knee ACL was significantly different depending on whether the knee

Steven W. Arms; Malcolm H. Pope; Robert J. Johnson; Richard A. Fischer; Inga Arvidsson; Ejnar Eriksson

1984-01-01

80

Prevention of anterior cruciate ligament injuries in soccer  

Microsoft Academic Search

Proprioceptive training has been shown to reduce the incidence of ankle sprains in different sports. It can also improve rehabilitation after anterior cruciate ligament (ACL) injuries whether treated operatively or nonoperatively. Since ACL injuries lead to long absence from sports and are one of the main causes of permanent sports disability, it is essential to try to prevent them. In

A. Caraffa; G. Cerulli; M. Projetti; G. Aisa; A. Rizzo

1996-01-01

81

Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity  

PubMed Central

Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation. PMID:20808583

Kim, Sung-Jae; Kumar, Praveen

2010-01-01

82

Silk matrix for tissue engineered anterior cruciate ligaments  

Microsoft Academic Search

A silk-fiber matrix was studied as a suitable material for tissue engineering anterior cruciate ligaments (ACL). The matrix was successfully designed to match the complex and demanding mechanical requirements of a native human ACL, including adequate fatigue performance. This protein matrix supported the attachment, expansion and differentiation of adult human progenitor bone marrow stromal cells based on scanning electron microscopy,

Gregory H Altman; Rebecca L Horan; Helen H Lu; Jodie Moreau; Ivan Martin; John C Richmond; David L Kaplan

2002-01-01

83

Proprioception in the anterior cruciate deficient knee  

Microsoft Academic Search

Proprioception was quantified in a group of patients who had documented complete ACL tears. Threshold to detection of passive change in position of the knee was measured using a well-described test. Eleven pa tients with arthroscopically proven complete ACL tears and findings consistent with moderate to severe anter olateral rotatory instability were tested. Testing was done within the 30° to

Robert L. Barrack; Harry B. Skinner; Steven L. Buckley

1989-01-01

84

Arthroscopic management of a chronic primary anterior shoulder dislocation.  

PubMed

Chronic anterior dislocation of the glenohumeral joint often leads to functional impairment and pain. Duration of dislocation is correlated with complications, and this injury is traditionally treated with an open procedure. A right-hand - dominant woman in her late 70s presented with traumatic chronic anterior dislocation of the glenohumeral joint. Her physical exam and imaging studies were consistent with anterior shoulder dislocation, a large Hill-Sachs deformity, and rotator cuff and anterior labral tears. A shoulder reduction under anesthesia was performed followed by an arthroscopic double-row rotator cuff repair. In addition, a labral repair was performed via percutaneously inserted suture anchors. Following this treatment, stability was restored to the glenohumeral joint. The patient progressed well with physical therapy and, at 1-year follow-up, the patient had returned to all routine activities pain-free. Arthroscopic repair of chronic primary traumatic anterior shoulder dislocations requiring surgical treatment is a valuable alternative to open procedures and should be considered in higher-functioning elderly patients. Percutaneous suture anchor placement minimizes trauma to an already pathologic rotator cuff and joint capsule. PMID:20844774

Galano, Gregory J; Dieter, Alexis A; Moradi, Natan E; Ahmad, Christopher S

2010-07-01

85

Activity progression for anterior cruciate ligament injured individuals?  

PubMed Central

Background Functional exercises are important in the rehabilitation of anterior cruciate ligament deficient and reconstructed individuals but movement compensations and incomplete recovery persist. This study aimed to identify how tasks pose different challenges; and evaluate if different activities challenge patient groups differently compared to controls. Methods Motion and force data were collected during distance hop, squatting and gait for 20 anterior cruciate ligament deficient, 21 reconstructed and 21 controls. Findings Knee range of motion was greatest during squatting, intermediate during hopping and smallest during gait (P < 0.01). Peak internal knee extensor moments were greatest during distance hop (P < 0.01). The mean value of peak knee moments was reduced in squatting and gait (P < 0.01) compared to hop. Peak internal extensor moments were significantly larger during squatting than gait and peak external adductor moments during gait compared to squatting (P < 0.01). Fluency was highest during squatting (P < 0.01). All patients demonstrated good recovery of gait but anterior cruciate ligament deficient adopted a strategy of increased fluency (P < 0.01). During squatting knee range of motion and peak internal knee extensor moment were reduced in all patients (P < 0.01). Both anterior cruciate ligament groups hopped a shorter distance (P < 0.01) and had reduced knee range of motion (P < 0.025). Anterior cruciate ligament reconstructed had reduced fluency (P < 0.01). Interpretation Distance hop was most challenging; squatting and gait were of similar difficulty but challenged patients in different ways. Despite squatting being an early, less challenging exercise, numerous compensation strategies were identified, indicating that this may be more challenging than gait. PMID:24447417

Button, Kate; Roos, Paulien E.; van Deursen, Robert W.M.

2014-01-01

86

Anterior Cruciate Ligament—Injured Subjects Have Smaller Anterior Cruciate Ligaments Than Matched ControlsA Magnetic Resonance Imaging Study  

Microsoft Academic Search

Background: Very few studies examining the predisposing anatomical factors leading to anterior cruciate ligament (ACL) injuries have examined the ACL itself, and none of these directly examined the difference in ACL properties between injured and matched control subjects.Hypothesis: The ACL total volume in people who have experienced a noncontact ACL injury is smaller than that of matched controls.Study Design: Case

Ajit M. W. Chaudhari; Eric A. Zelman; David C. Flanigan; Christopher C. Kaeding; Haikady N. Nagaraja

2009-01-01

87

Anterior cruciate ligament recostruction with bone-patellar tendon-bone autograft in Tanner 3 stage patients with open physes.  

PubMed

Ten skeletally immature patients were treated with an arthroscopic-assisted anterior cruciate ligament reconstruction with bone-patellar tendon bone autograft (compass, 50-55°; holes, 7-9 mm). Radiological assessments (standard radiograph), Orthopädische Arbeitsgruppe Knie (OAK) score and KT 1000, were conducted on all patients, 1 year after surgery. Skeletal maturity had been reached by all patients and no complications were observed. All patients returned to their preinjury sport level. Drilling more vertical tunnels when bone-tendon-bone autograft was chosen to avoid partial epiphysiodesis and offers good functional and isometric results. PMID:21886009

Memeo, Antonio; Pedretti, Leopoldo; Miola, Francesca; Albisetti, Walter

2012-09-01

88

Arthroscopic Treatment of Acute Tibial Avulsion Fracture of the Posterior Cruciate Ligament Using the TightRope Fixation Device  

PubMed Central

Avulsion fracture of the posterior cruciate ligament from its tibial insertion is a rare condition. Early surgical treatment has been regarded as necessary, but the optimal surgical technique remains unclear. The purpose of this technical note is to present a novel all-inside arthroscopic reconstruction technique for bony tibial avulsion fractures of the posterior cruciate ligament using the TightRope device (Arthrex, Naples, FL). PMID:25126507

Gwinner, Clemens; Kopf, Sebastian; Hoburg, Arnd; Haas, Norbert P.; Jung, Tobias M.

2014-01-01

89

Replacement of the anterior cruciate ligament of the knee with deep frozen bone-tendon-bone allografts.  

PubMed

Surgical treatment of the torn anterior cruciate ligament (ACL) and consequent knee instability showed great development over the last decade. Arthroscopic techniques and the use of different allogenic tissues became a routine. Between 1995 and 1998, 31 knees in 30 patients underwent ACL reconstruction of the knee with fresh-frozen allografts at the Department of Orthopedics, Medical University of Pécs, Hungary. The operations were performed with arthroscopic technique. This paper retrospectively assesses the outcomes with an average follow up of 28 months, which showed good results in most of the cases. The authors reviewed the literature emphasizing advantages and disadvantages of the method with special interest to possible complications resulting from the use of allografts: graft rejection, graft re-rupture, transmission of infection and synovitis evoked by immune response. PMID:10853785

Than, P; Bálint, L; Domán, I; Szabó, G

1999-01-01

90

Recent advances in the rehabilitation of anterior cruciate ligament injuries.  

PubMed

Rehabilitation following anterior cruciate ligament surgery continues to change, with the current emphasis being on immediate weight bearing and range of motion, and progressive muscular strengthening, proprioception, dynamic stability, and neuromuscular control drills. The rehabilitation program should be based on scientific and clinical research and focus on specific drills and exercises designed to return the patient to the desired functional goals. The goal is to return the patient's knee to homeostasis and the patient to his or her sport or activity as safely as possible. Unique rehabilitation techniques and special considerations for the female athlete will also be discussed. The purpose of this article is to provide the reader with a thorough scientific basis for anterior cruciate ligament rehabilitation based on graft selection, patient population, and concomitant injuries. PMID:22382825

Wilk, Kevin E; Macrina, Leonard C; Cain, E Lyle; Dugas, Jeffrey R; Andrews, James R

2012-03-01

91

Early radiographic features in patients with anterior cruciate ligament rupture  

Microsoft Academic Search

OBJECTIVETo determine, in a preliminary cross sectional study of patients with anterior cruciate ligament (ACL) ruptured knees, which of the radiographic features—subchondral cortical plate thickness, trabecular sclerosis, and osteophytosis—appears before or in association with changes in joint space width (JSW) as a surrogate for articular cartilage thickness in patients with ruptured knees.METHODS19 patients (14 men), mean (95% CI) age 28.7

J C Buckland-Wright; J A Lynch; B Dave

2000-01-01

92

Tissue Engineering Strategies for Regeneration of the Anterior Cruciate Ligament  

Microsoft Academic Search

The anterior cruciate ligament (ACL) is a primary stabilizer of the knee joint that is frequently injured, compromising knee\\u000a stability and leading to degeneration of other joint structures. Because the ACL has a poor intrinsic healing capacity, surgical\\u000a reconstruction is required to restore knee function in young active patients. Biological grafts are the gold standard for\\u000a ACL reconstruction, resulting in

Michael G. Dunn

93

[Injuries of the anterior cruciate ligament in athletes].  

PubMed

Anterior cruciate ligament ruptures represent serious injuries for athletes which are often associated with accompanying injuries and lead to relevant kinematic alterations in the femorotibial roll-glide mechanism of the knee joint. Instability resulting in recurrent giving way events, as well as instability-related meniscal and cartilage lesions can cause functional long-term impairment that may limit the athlete's career. Anterior cruciate ligament replacement is therefore considered to be the gold standard for recovery of physical performance and to prevent secondary meniscal and cartilage damage. Continuous changes in the reconstruction of the anterior cruciate ligament have led to a variety of different methods, including graft choice, fixation devices and surgical techniques, which support the consideration of individual requirements of the athlete as well as sport-specific aspects. One of the main factors for restoring stability and the physiological kinematic roll-glide mechanism of the knee is an anatomical tunnel placement as well as a stable graft fixation in the tibia and femur. By achieving of these fundamental technical requirements an early functional rehabilitation and accelerated recovery of neuromuscular skills, strength and coordination can be achieved, so that an early return to sport activities is possible. PMID:25225041

Shafizadeh, S; Schneider, M M; Bouillon, B

2014-10-01

94

Bone tunnel enlargement on anterior cruciate ligament reconstruction  

PubMed Central

Objective: To assess the presence of tibial bone tunnel enlargement after surgical reconstruction of the anterior cruciate ligament using quadruple graft of the flexor tendons and correlate the functional results in their presence. Methods: The studied lasted six months and included 25 patients, with ages ranging from 18 to 43 years old. Assessment was based on radiographs taken immediately postoperatively and at the third and sixth month of follow up in the anterior cruciate ligament reconstruction. Reconstruction of ligaments was performed with tendon grafts of the semitendinosus and gracilis muscle fixated in the femur with transverse metal screw and in the tibia with interference screws. Patients were evaluated objectively by tests ligament, graded from zero to four crosses and subjectively by the Lysholm method preoperative and after sixth month follow up. Results: Significant increase in the tunnels diameters were observed, 20.56% for radiographs in the anteroposterior view, 26.48% in profile view and 23.22% in computed tomography. Descriptive statistics showed significant improvement in subjective and objective clinical parameters. Conclusions: The bone tunnel enlargement is a phenomenon found in the first months after surgical reconstruction of the anterior cruciate ligament and it has no implications on clinical outcomes in the short term. Level of Evidence II, Prospective Study. PMID:25328430

Leonardi, Adriano Barros de Aguiar; Duarte, Aires; Severino, Nilson Roberto

2014-01-01

95

Therapeutic potential of anterior cruciate ligament-derived stem cells for anterior cruciate ligament reconstruction.  

PubMed

We recently reported that the ruptured regions of the human anterior cruciate ligament (ACL) contained vascular-derived stem cells, which showed the potential for high expansion and multilineage differentiation. In this study, we performed experiments to test the hypothesis that ACL-derived CD34(+) cells could contribute to tendon-bone healing. ACL-derived cells were isolated from the rupture site of human ACL by fluorescence-activated cell sorting. Following ACL reconstruction, immunodeficient rats received intracapsular administration of either ACL-derived CD34(+) cells, nonsorted (NS) cells, CD34(+) cells, or phosphate-buffered saline (PBS). We also performed in vitro cell proliferation assays and enzyme-linked immunosorbent assays for vascular endothelial growth factor (VEGF) secretion. We confirmed the recruitment of the transplanted cells into the perigraft site after intracapuslar injection by immunohistochemical staining at week 1. Histological evaluation showed a greater area of collagen fiber formation and more collagen type II expression in the CD34(+) group than the other groups at the week 2 time point. Immunostaining with isolectin B4 and rat osteocalcin demonstrated enhanced angiogenesis and osteogenesis in the CD34(+) group at week 2. Moreover, double immunohistochemical staining for human-specific endothelial cell (EC) and osteoblast (OB) markers at week 2 demonstrated a greater ability of differentiation into ECs and OBs in the CD34(+) group. Microcomputerized tomography showed the greatest healing of perigraft bone at week 4 in the CD34(+) cell group, and the failure load of tensile test at week 8 demonstrated the greatest biomechanical strength in the CD34(+) group. Furthermore, the in vitro studies indicated that the CD34(+) group was superior to the other groups in their cell proliferation and VEGF secretion capacities. We demonstrated that ACL-derived CD34(+) cells contributed to the tendon-bone healing after ACL reconstruction via the enhancement of angiogenesis and osteogenesis, which also contributed to an increase in biomechanical strength. PMID:22732227

Mifune, Yutaka; Matsumoto, Tomoyuki; Ota, Shusuke; Nishimori, Makoto; Usas, Arvydas; Kopf, Sebastian; Kuroda, Ryosuke; Kurosaka, Masahiro; Fu, Freddie H; Huard, Johnny

2012-01-01

96

Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using a Three-Dimensional Fluoroscopic Navigation System  

PubMed Central

Introduction Recently, remnant-preserving anterior cruciate ligament (ACL) reconstruction has been increasingly performed to achieve revascularization, cell proliferation, and recovery of high-quality proprioception. However, poor arthroscopic visualization makes accurate socket placement during remnant-preserving ACL reconstruction difficult. This study describes a surgical technique used to create an anatomical femoral socket with a three-dimensional (3D) fluoroscopy based navigation system during technically demanding remnant-preserving ACL reconstruction. Surgical Technique After a reference frame was attached to the femur, an intraoperative image of the distal femur was obtained, transferred to the navigation system and reconstructed into a 3D image. A navigation computer helped the surgeon visualize the entire lateral wall of the femoral notch and lateral intercondylar ridge, even when the remnant of the ruptured ACL impeded arthroscopic visualization of the bone surface. When a guide was placed, the virtual femoral tunnel overlapped the reconstructed 3D image in real time; therefore, only minimal soft tissue debridement was required. Materials and Methods We treated 47 patients with remnant-preserving ACL reconstruction using this system. The center of the femoral socket aperture was calculated according to the quadrant technique using 3D computed tomography imaging. Results The femoral socket locations were considered to be an anatomical footprint in accordance with previous cadaveric studies. Conclusions The 3D fluoroscopy-based navigation can assist surgeons in creating anatomical femoral sockets during remnant-preserving ACL reconstruction. PMID:25229047

Inui, Hiroshi; Sanada, Takaki; Nakamura, Kensuke; Yamagami, Ryota; Masuda, Hironari; Tanaka, Sakae; Nakagawa, Takumi

2014-01-01

97

Popliteal pseudoaneurysm after arthroscopic posterior cruciate ligament reconstruction.  

PubMed

This report presents the case of a 30-year-old motocross (BMX) cyclist with a third-degree posterior cruciate ligament rupture. The technique used for reconstruction was the transtibial single-bundle autologous hamstring technique. Unfortunately, the procedure was complicated by a popliteal pseudoaneurysm, which was located in line with the tibial canal. The pseudoaneurysm was treated with an end-to-end anastomosis and the patient recovered without further complaints. In this case, the popliteal artery was damaged most probably by the edge of the reamer or the guide wire during removal. Vascular complications can be limb- and life-threatening. This case report aims to increase the awareness of this serious complication with a review of the literature. PMID:25229050

van Dorp, Karin B; Breugem, Stefan J M; Driessen, Marcel J M

2014-09-01

98

Popliteal Pseudoaneurysm after Arthroscopic Posterior Cruciate Ligament Reconstruction  

PubMed Central

This report presents the case of a 30-year-old motocross (BMX) cyclist with a third-degree posterior cruciate ligament rupture. The technique used for reconstruction was the transtibial single-bundle autologous hamstring technique. Unfortunately, the procedure was complicated by a popliteal pseudoaneurysm, which was located in line with the tibial canal. The pseudoaneurysm was treated with an end-to-end anastomosis and the patient recovered without further complaints. In this case, the popliteal artery was damaged most probably by the edge of the reamer or the guide wire during removal. Vascular complications can be limb- and life-threatening. This case report aims to increase the awareness of this serious complication with a review of the literature. PMID:25229050

Breugem, Stefan J.M.; Driessen, Marcel J.M.

2014-01-01

99

To Study the Incidence of Heterotopic Ossification After Anterior Cruciate Ligament Reconstruction  

PubMed Central

Introduction: Previous studies have enumerated the advantages of an arthroscopic Anterior Cruciate Ligament (ACL) reconstruction with the use of a Bone Patellar Tendon Bone (BPTB) graft. Complications are extremely rare in such surgeries and one such known complication, which is an extra-articular heterotophic ossification at the femoral tunnel site, is rarely seen only in few patients. Aim: To evaluate the incidence of heterotrophic ossifications at the femoral tunnel site and the efficacy of the preventive measures which were undertaken, in patients who had undergone ACL reconstructions with the use of bone patellar tendon bone grafts. Material and Methods: A total of 285 patients who had ACL tears within a duration of six years, were evaluated prospectively for the incidence of heterotrophic ossifications after they underwent arthroscopic reconstructions with the use of bone patellar tendon bone grafts by the double incision technique. The effect of the efficacy of various preventive measures on the incidence of the heterotophic ossifications post surgery was also studied. Results: The observed incidence of the heterotophic ossifications was 2.58% in patients whom preventive measures were not used. In contrast, an incidence of 1.54% of similar complications was recorded, after preventive measures were undertaken. Our results showed that heterotophic ossifications after arthroscopic reconstructions with the use of bone patellar tendon bone grafts were a rare complication and that their incidence could be further reduced if preventive measures were taken. Conclusion: The heterotophic ossification is a rare complication after an ACL reconstruction is done with the use of a bone patellar tendon bone graft by the double incision technique. Its incidence reduces significantly after preventive measures are undertaken. PMID:23814735

Bhandary, Bhaskara; Shetty, Sudeep; Bangera, Vinay V.; R., Yogaprakash; Kassim, Mohammed Shabir; Alva, Karan; Bhandary, Sudarshan

2013-01-01

100

Accelerated rehabilitation after anterior cruciate ligament reconstruction  

Microsoft Academic Search

To overcome many of the complications after ACL reconstruction (prolonged knee stiffness, limitation of complete extension, delay in strength recovery, anterior knee pain), yet still maintain knee stability, we devel oped a rehabilitation protocol that emphasizes full knee extension on the first postoperative day and immediate weightbearing according to the patient's tolerance. Of 800 patients who underwent intraarticular ACL patellar

K. Donald Shelbourne; Paul Nitz

1990-01-01

101

Arthroscopic Augmentation With Subscapularis Tendon in Anterior Shoulder Instability With Capsulolabral Deficiency  

PubMed Central

The treatment of chronic shoulder instability with poor quality of the anterior capsulolabral tissue is still controversial. In these cases the Latarjet procedure is certainly more effective in preventing recurrence than an arthroscopic capsular repair. However, several studies have reported a variety of severe complications related to the Latarjet procedure because of the use of bone augmentation and hardware implantation; moreover, the arthroscopic version of the Latarjet procedure is technically difficult and potentially dangerous because of the proximity of neurovascular structures. The aim of this report is to describe an innovative arthroscopic technique consisting of an augmentation of the anterior capsulolabral tissue using the articular portion of the subscapularis tendon and knotless suture anchors paired with high-strength tape for its fixation to the anterior glenoid edge. In the absence of severe bone deficiency of the anterior glenoid edge, this procedure can minimize arthroscopic technique failures, restoring the anterior capsulolabral wall without any significant reduction of shoulder functionality. PMID:24266004

Maiotti, Marco; Massoni, Carlo

2013-01-01

102

In vivo kinematics for subjects with and without an anterior cruciate ligament.  

PubMed

The objective of the current study was to compare kinematic patterns of anterior cruciate retaining total knee arthroplasty and posterior stabilized total knee arthroplasty. Fifteen patients received an anterior cruciate retaining total knee arthroplasty and 15 received a posterior stabilized total knee arthroplasty. All total knee arthroplasties were clinically successful (Hospital for Special Surgery score > 90). Each patient was examined during level walking using fluoroscopy. Femorotibial contact paths for the medial and lateral condyles were determined using a computer automated model-fitting technique. Ten of 15 (67%) patients receiving an anterior cruciate retaining total knee arthroplasty and 12 of 15 patients (80%) receiving a posterior stabilized total knee arthroplasty experienced anterior contact at some phase of the gait cycle. Anterior contact in anterior cruciate retaining total knee arthroplasty can be attributed to the presence of the anterior cruciate ligament, resisting the anterior tibial shear forces during gait. The reason for anterior contact observed in posterior stabilized total knee arthroplasty is unclear, possibly related to the sagittal topography (dwell-point position) of the tibial component. Increased axial rotation was seen in anterior cruciate retaining total knee arthroplasty possibly because of the preservation of the four-bar linkage within the knee. Patients receiving an anterior cruciate retaining total knee arthroplasty experienced kinematic patterns more similar to the normal knee. PMID:12439275

Komistek, Richard D; Allain, Jerome; Anderson, Dylan T; Dennis, Douglas A; Goutallier, Daniel

2002-11-01

103

Arthroscopic surgery for treatment of anterior displacement of the disc without reduction of the temporomandibular joint  

Microsoft Academic Search

The aim of this study was to investigate the clinical results and efficacy of an arthroscopic approach to correct anterior displacement of the disc without reduction of the temporomandibular joint (TMJ) with limitation of mouth opening. We studied 28 joints with internal derangement in 23 patients, all of whom had had arthroscopic surgery (lavage, lysis of adhesions in the superior

Yaomin Zhu; Cangshang Zheng; Yongqiang Deng; Yang Wang

104

Autografts commonly used in anterior cruciate ligament reconstruction.  

PubMed

Anterior cruciate ligament reconstruction is among the most common orthopaedic procedures in the United States, with >200,000 performed annually. Much has been published regarding the use of autograft versus allograft. Bone-patellar tendon-bone is the most frequently used autograft, but hamstring and quadriceps tendon grafts are common alternatives. Each graft has distinct advantages and disadvantages, and selection is individualized. Fixation methods vary by graft type. Fixation resulting in a construct that is too rigid may restrict knee range of motion. Donor site morbidity must be considered, as well. Autograft harvest may result in anterior knee pain, kneeling pain, anterior knee numbness, muscle weakness, and patellar fracture. Appropriate graft selection is essential to optimize outcomes. PMID:21536625

Shelton, Walter R; Fagan, Bryan C

2011-05-01

105

Postoperative pain after anterior cruciate ligament reconstruction using a transligamentous approach  

Microsoft Academic Search

Anterior cruciate ligament reconstruction by free patel lar tendon graft was performed using 2 different surgical approaches to the intercondylar notch in 67 consecu tive patients with chronic anterior cruciate ligament insufficiency. In the first 30 patients (Group A), the traditional medial parapatellar arthrotomy with lateral luxation of the patella was done, whereas in the last 37 patients (Group B)

Eirik Solheim; Torbjørn Strand

1993-01-01

106

Are Meniscus and Cartilage Injuries Related to Time to Anterior Cruciate Ligament Reconstruction?  

Microsoft Academic Search

Background: Functional instability after anterior cruciate ligament injury can be successfully treated with ligament reconstruction. However, the associated meniscus and cartilage lesions often cannot be repaired and may have long-term detrimental effects on knee function.Purpose: The authors used the large database within the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry to evaluate time to surgery, age, and gender as risk

Ankur M. Chhadia; Maria C. S. Inacio; Gregory B. Maletis; Rick P. Csintalan; Brent R. Davis; Tadashi T. Funahashi

2011-01-01

107

A long-term study of anterior cruciate ligament allograft reconstruction.  

PubMed

We retrospectively reviewed the long-term clinical outcome of unilateral arthroscopic anterior cruciate ligament (ACL) allograft reconstruction. From October 1995 to December 1997, 64 arthroscopic ACL reconstructions were performed. Multiligamentous knee injuries and ACL injuries in polytrauma patients were excluded and out of the remaining 60 patients 55 were available for follow-up. Three patients had suffered a rerupture caused by major trauma. One patient had a rerupture without significant trauma and one failure was caused by deep infection. These five patients were revised. Fifty patients (36 males, 14 females) were included in the final follow-up. At the time of evaluation, the mean duration of follow-up was 10 years and 6 months. All patients were examined by an independent examiner. Seven patients had an extension lag (<5 degrees) and all patients had a knee flexion of at least 120 degrees, with a mean flexion of 135 +/- 5 degrees compared to 135 +/- 8 degrees. At the time of follow-up, the median IKDC score was 97 (74-100). The Lysholm scoring scale had a median value of 95 (76-100). The median sports level on the Tegner scale was 6 (4-9). The one-leg-hop test showed a mean value of 95 +/- 5%. One patient did not perform the one-leg-hop test because of recent surgery to the Achilles tendon. In conclusion, the tibialis anterior or tibialis posterior tendon allograft ACL reconstruction produced good clinical results in the majority of patients at long-term follow-up. PMID:19421736

Almqvist, K F; Willaert, Pieter; De Brabandere, S; Criel, K; Verdonk, R

2009-07-01

108

Electromyographic analysis of the anterior cruciate ligament-deficient knee.  

PubMed

The protective relationship of the human anterior cruciate ligament (ACL) by active contraction of the hamstring musculature has been known and understood by sports orthopedists and physical therapists for many years. Rehabilitation programs for patients with torn ACLs as well as those treated with ligament reconstruction have always stressed hamstring strengthening. Research in this area during the past decade has begun to define the proprioceptive mechanism that governs this relationship as well as the actual recording of dynamic muscle firing patterns in pre- and postoperative subjects. Laboratory studies suggest that altered hamstring activity may help these subjects compensate for a knee that is lax because of ACL damage. PMID:8458152

Tibone, J E; Antich, T J

1993-03-01

109

Prevention of anterior cruciate ligament injury in the female athlete  

PubMed Central

The relationships of gender, age and training to the incidence of anterior cruciate ligament (ACL) injury are pivotal to developing a comprehensive neuromuscular and proprioceptive training programme to decrease ACL injuries in female athletes. A prophylactic neuromuscular and proprioceptive training programme may have direct benefit in decreasing the number of ACL injuries in female athletes. This research foundation endorses further epidemiological and biomechanical studies to determine the exact mechanism of ACL injury and the most effective intervention for decreasing ACL injuries in this high?risk population. PMID:17609222

Silvers, Holly Jacinda; Mandelbaum, Bert R

2007-01-01

110

Anterior cruciate ligament reconstruction: which graft is best?  

PubMed

Abstract For the last 4 decades, since the initial use of the patellar tendon for anterior cruciate ligament (ACL) reconstruction, there has been controversy regarding the ideal graft choice for this procedure. Beside bone-patellar tendon-bone autografts, several other graft choices have become popular, including hamstring tendon and a variety of allografts. Within the past 5 years, several randomized and nonrandomized studies have compared the graft choices in ACL reconstruction. However, the question still remains: Is there an ideal graft for ACL reconstruction? The purpose of this review is to assess the most recent data, identifying if there truly is an ideal graft choice. PMID:15525931

Sherman, Orrin H; Banffy, Michael B

2004-11-01

111

Anterior cruciate ligament graft choices: a review of current concepts.  

PubMed

The graft choice for anterior cruciate ligament (ACL) reconstruction continues to be controversial. There are several options available for the treating surgeon, including Bone Patellar Tendon Bone (BPTB) grafts, Hamstring tendon (HT) grafts, allografts and synthetic grafts. Within the last decade there have been several comparative trials and meta-analysis, which have failed to provide an answer with regards to the best graft available. The aim of this review is to understand the current concepts in graft choices for ACL reconstruction. PMID:22888379

Dheerendra, Sujay K; Khan, Wasim S; Singhal, Rohit; Shivarathre, Deepak G; Pydisetty, Ravi; Johnstone, David

2012-01-01

112

Mucoid degeneration of the anterior cruciate Ligament: a case report  

PubMed Central

We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Mucoid degeneration of the ACL is a very rare cause of knee pain. There have been only some reported cases of mucoid degeneration of the ACL in the English literature. We reviewed previous reports and summarized clinical features and symptoms, including those found in our case. Magnetic Resonance Imaging is the most useful tool for differentiating mucoid degeneration of the ACL from an intraligamentous ganglion or other lesions in the knee joint. If this disease is considered preoperatively, it can be diagnosed easily based on characteristic findings. PMID:24147185

el Kadi, Khalid Ibn; Marcaillou, Florian; Blanc, Stephane; Salloum, Bassam; Dimontagliari, Cyril; Boutayeb, Fawzi

2013-01-01

113

Mucoid degeneration of the anterior cruciate ligament: a case report.  

PubMed

We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Mucoid degeneration of the ACL is a very rare cause of knee pain. There have been only some reported cases of mucoid degeneration of the ACL in the English literature. We reviewed previous reports and summarized clinical features and symptoms, including those found in our case. Magnetic Resonance Imaging is the most useful tool for differentiating mucoid degeneration of the ACL from an intraligamentous ganglion or other lesions in the knee joint. If this disease is considered preoperatively, it can be diagnosed easily based on characteristic findings. PMID:24147185

el Kadi, Khalid Ibn; Marcaillou, Florian; Blanc, Stephane; Salloum, Bassam; Dimontagliari, Cyril; Boutayeb, Fawzi

2013-01-01

114

The anterior cruciate ligament-deficient knee and unicompartmental arthritis.  

PubMed

Treatment of medial and lateral compartment arthritis in the anterior cruciate ligament (ACL)-deficient knee remains a topic of debate among orthopedic surgeons. This article discusses the treatment options for the ACL-deficient knee with unicompartmental arthritis and provides a rationale for clinical decision making in this difficult group of patients. Unicondylar knee arthroplasty (UKA) is a viable option in a select group of patients to decrease pain and maintain an active lifestyle. When performing a UKA in an ACL-deficient knee, it is important to manage appropriate expectations for a successful outcome. PMID:24274844

Plancher, Kevin D; Dunn, Albert S M; Petterson, Stephanie C

2014-01-01

115

Anterior Cruciate Ligament Graft Choices: A Review of Current Concepts  

PubMed Central

The graft choice for anterior cruciate ligament (ACL) reconstruction continues to be controversial. There are several options available for the treating surgeon, including Bone Patellar Tendon Bone (BPTB) grafts, Hamstring tendon (HT) grafts, allografts and synthetic grafts. Within the last decade there have been several comparative trials and meta-analysis, which have failed to provide an answer with regards to the best graft available. The aim of this review is to understand the current concepts in graft choices for ACL reconstruction. PMID:22888379

Dheerendra, Sujay K; Khan, Wasim S; Singhal, Rohit; Shivarathre, Deepak G; Pydisetty, Ravi; Johnstone, David

2012-01-01

116

Does concomitant meniscectomy affect medium-term outcome of anterior cruciate ligament reconstruction? A preliminary report  

PubMed Central

Introduction Anterior cruciate ligament (ACL) injury is often accompanied by injuries of the menisci. In order to restore knee stability, anterior cruciate ligament reconstruction (ACLR) is performed, with meniscus surgery when needed. The purpose of this study was to assess the medium-term outcome of ACLR in subjects with and without concomitant meniscus tear and partial meniscectomy. Material and methods We prospectively studied 73 patients after arthroscopically assisted bone-patellar tendon-bone ACLR. Subjects were divided into two subgroups: those who had only ACLR (group A, 54 subjects with mean age 28, (SD 9)) and those who underwent both ACLR and concomitant partial meniscectomy (group B, 19 subjects, mean age 32 [11]). Subjects completed a disease-specific questionnaire, the Knee injury and Osteoarthritis Outcome Score (KOOS), preoperatively and at a minimum follow-up of 1 year. Results No differences in mean scores between group A and B were observed either preoperatively or at follow-up. We found a significant change in mean score in the KOOS subscale QoL in group A following ACLR (? = 9 points, p = 0.039). Most subjects improved in the KOOS subscales Sports and Recreation and QoL in both group A (59 and 52% respectively) and B (63 and 47% respectively). Eight subjects (15%) from group A and 1 (5%) from group B fulfilled criteria of functional recovery. Criteria of treatment failure were fulfilled in 17 subjects (32%) from A and 4 (21%) from group B. Conclusions Patients undergoing ACLR with partial meniscectomy had a similar medium-term outcome compared to individuals with ACL tear alone. PMID:25395952

K?ska, Rafa?; Wito?ski, Dariusz

2014-01-01

117

The effect of progressive degrees of medial meniscal loss on stability after anterior cruciate ligament reconstruction.  

PubMed

Previous studies report conflicting results on whether loss of the medial meniscus compromises knee stability after reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to determine whether the degree of medial meniscus deficiency affects the stability of the ACL-reconstructed knee. Six cadaveric knees were arthroscopically reconstructed with bone-patellar tendon-bone autografts using an anatomic "footprint" technique. Knees tested were ACL-deficient and after reconstruction under three different meniscal states: with partial medial meniscectomy, subtotal meniscectomy, and meniscal root transection. Biomechanical testing was performed at 30 and 60 degrees of flexion under two loading conditions: (1) 134-N anterior tibial load termed anterior tibial translation (ATT) and (2) 10-Nm valgus load combined with 5 Nm of internal tibial torque termed provocative pivot maneuver (PPM). Knee kinematics was measured using a custom activity simulator, motion analysis system, and three-dimensional CT reconstructions. During both ATT and PPM loading, ACL deficiency resulted in a significant increase in anterior translation compared with knees with an intact ACL or those that had undergone ACL reconstruction (p < 0.05). Neither the addition of a partial nor subtotal medial meniscectomy led to increased instability. Only after medial meniscal root transection was increased instability of the ACL-deficient knee detected compared with intact, partial, or subtotal meniscectomy states (p < 0.01). In all states of meniscal deficiency, ACL reconstruction restored internal tibial rotation and anterior translation at 30 degrees to that of the intact knee (p > 0.05). Anatomic single bundle ACL reconstruction was able to restore knee stability in all conditions of medial meniscal deficiency. PMID:23512542

McCulloch, Patrick C; Shybut, Theodore B; Isamaily, Sabir K; Durrani, Salim; Gold, Johnathan E; Noble, Philip C; Lintner, David M

2013-10-01

118

Combined reconstruction for posterolateral rotatory instability with anterior cruciate ligament injuries of the knee.  

PubMed

If posterolateral rotatory instability (PLRI) injury in patients with a torn anterior cruciate ligament (ACL) is not diagnosed and treated, ACL reconstruction can fail. We retrospectively evaluated the clinical outcome after reconstructions between 2002 and 2007 of both the ACL and the posterolateral corner (PLC) in 44 knees with combined ACL and PLC injuries. The median follow-up duration was 49 months (range, 24-68 months). ACL reconstruction employed autogenous hamstring grafts from the ipsilateral knee. For grade II PLRI, a posterolateral corner sling through the fibular head was placed obliquely from the anteroinferior aspect to the posterosuperior aspect using autogenous hamstring grafts of the contralateral knee. Clinical outcomes were evaluated using the OAK (Orthopadishe Arbeitsgruppe Knie) and IKDC (International Knee Documentation Committee) knee scoring systems. Anterior stability was measured on pull stress radiographs using a Telos stress device and the manual maximum displacement test using a KT-1000 arthrometer with the knee flexed 30 degrees. PLRI was classified according to varus and rotational instability preoperatively and at final follow-up. Median OAK scores improved from 71 points (range, 48-86) to 93 points (range, 75-100). Satisfactory IKDC results were achieved in 39 knees (89%). As for anterior stability, as measured by anterior stress radiography, mean side-to-side displacement difference dropped significantly from 6.9 +/- 1.9 preoperatively to 1.4 +/- 1.1 mm at final follow-up. Forty patients (91%) had the same or better rotational stability compared to the normal side. Varus stress radiographs showed mean side-to-side displacement differences dropped from 1.8 +/- 1.7 preoperatively to 0.4 +/- 0.8 mm at final follow-up. Thus, chronic ACL deficiency is often accompanied by grade II PLRI and can be treated successfully by arthroscopic ACL reconstruction paired with posterolateral reconstruction employing a single sling through the fibular tunnel and a hamstring tendon autograft. PMID:20182869

Lee, Sang Hak; Jung, Young Bok; Jung, Ho Joong; Song, Kwang Sup; Ko, Young Bong

2010-09-01

119

Injury Mechanisms for Anterior Cruciate Ligament Injuries in Team HandballA Systematic Video Analysis  

Microsoft Academic Search

Objective: To describe the mechanisms for anterior cruciate ligament injuries in female team handball.Study Design: Descriptive video analysis.Methods: Twenty videotapes of anterior cruciate ligament injuries from Norwegian or international competition were collected from 12 seasons (1988-2000). Three medical doctors and 3 national team coaches systematically analyzed these videos to describe the injury mechanisms and playing situations. In addition, 32 anterior

Odd-Egil Olsen; Grethe Myklebust; Lars Engebretsen; Roald Bahr

2004-01-01

120

Modulation of proliferation and differentiation of human anterior cruciate ligament-derived stem cells by different growth factors.  

PubMed

We have previously isolated and identified stem cells from human cruciate ligaments. The goal of this study was to evaluate the proliferation and differentiation abilities of ligament-derived stem cells (LSCs) cultured with growth factors, including fibroblast growth factor 2 (FGF-2), epidermal growth factor, and transforming growth factor-beta 1 (TGF-b1). The ligament tissues were obtained from patients with anterior cruciate ligament injuries receiving arthroscopic surgeries. LSCs were obtained by collagenase digestion and plating as previously reported. Surface immunophenotype and the potential for trilineage differentiation into osteoblasts, chondrocytes, and adipocytes were confirmed. It was found that proliferation of the cells was enhanced with the addition of FGF-2 and TGF-b1. Upon TGF-b1 treatment, expression of collagen type I and type III, tenascin-c, fibronectin, and a-smooth muscle actin were significantly upregulated. Additionally, LSCs treated with TGF-b1 and FGF-2 increased the production of collagenous and noncollagenous extracellular matrix protein. Together, these results demonstrate that LSCs respond differently to various cytokines, and the results further validate the potential of using cruciate ligament tissue as a stem cell source for tissue engineering purposes. PMID:19586317

Cheng, Ming-Te; Yang, Hui-Wen; Chen, Tain-Hsiung; Lee, Oscar Kuang-Sheng

2009-12-01

121

Anterior cruciate ligament reconstructionThe effect of tibial tunnel placement on range of motion  

Microsoft Academic Search

In 111 patients who had anterior cruciate ligament reconstructions, postoperative radiographic measure ments of anterior to posterior and medial to lateral location of the tibial tunnels were correlated with the final range of motion achieved. In the 25 patients with extension deficits of 10° or more, placement of the tibial tunnel was more anterior (average, anterior 23% of the tibia)

Victor M. Romano; Ben K. Graf; James S. Keene; Richard H. Lange

1993-01-01

122

Superior labrum anterior to posterior lesions of the shoulder: Diagnosis and arthroscopic management  

PubMed Central

After the improvement in arthroscopic shoulder surgery, superior labrum anterior to posterior (SLAP) tears are increasingly recognized and treated in persons with excessive overhead activities like throwers. Several potential mechanisms for the pathophysiology of superior labral tears have been proposed. The diagnosis of this condition can be possible by history, physical examination and magnetic resonance imaging combination. The treatment of type 1 SLAP tears in many cases especially in older patients is non-operative but some cases need arthroscopic intervention. The arthroscopic management of type 2 lesions in older patients can be biceps tenodesis, but young and active patients like throwers will need an arthroscopic repair. The results of arthroscopic repair in older patients are not encouraging. The purpose of this study is to perform an overview of the diagnosis of the SLAP tears and to help decision making for the surgical management. PMID:25035838

Aydin, Nuri; Sirin, Evrim; Arya, Alp

2014-01-01

123

Outcome of double bundle anterior cruciate ligament reconstruction using crosspin and aperture fixation  

PubMed Central

Background: Double bundle anterior cruciate ligament (DBACL) reconstruction is said to reproduce the native anterior cruciate ligament (ACL) anatomy better than single bundle anterior cruciate ligament, whether it leads to better functional results is debatable. Different fixation methods have been used for DBACL reconstruction, the most common being aperture fixation on tibial side and cortical suspensory fixation on the femoral side. We present the results of DBACL reconstruction technique, wherein on the femoral side anteromedial (AM) bundle is fixed with a crosspin and aperture fixation was done for the posterolateral (PL) bundle. Materials and Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Results: The KT-1000 results were evaluated using paired t test with the P value set at 0.001. At the end of 1 year, the anteroposterior side to side translation difference (KT-1000 manual maximum) showed mean improvement from 5.1 mm ± 1.5 preoperatively to 1.6 mm ± 1.2 (P < 0.001) postoperatively. The Lysholm score too showed statistically significant (P < 0.001) improvement from 52.4 ± 15.2 (range: 32-76) preoperatively to a postoperative score of 89.1 ± 3.2 (range 67-100). According to the IKDC score 90% patients had normal results (Category A and B). The AM femoral tunnel initial posterior blow out was seen in 4 patients and confluence in the intraarticular part of the femoral tunnels was seen in 6 patients intraoperatively. The quadriceps strength on isokinetic testing had an average deficit of 10.3% while the hamstrings had a 5.2% deficit at the end of 1 year as compared with the normal side. Conclusion: Our study revealed that the DBACL reconstruction using crosspin fixation for AM bundle and aperture fixation for PL bundle on the femoral side resulted in significant improvement in KT 1000, Lysholm and IKDC scores. PMID:24600062

Joshi, Deepak; Jain, Vineet; Goyal, Ankit; Bahl, Vibhu; Modi, Prashant; Chaudhary, Deepak

2014-01-01

124

TriLink: Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction  

PubMed Central

Cadaveric and clinical biomechanical studies show improved kinematic restoration using double-bundle anterior cruciate ligament (ACL) reconstruction techniques. These have been criticized in the past for being technically challenging. We present a novel 3-socket approach for anatomic “all-inside” double-bundle reconstruction using a single hamstring tendon fashioned to create a trifurcate graft: the TriLink technique. The semitendinosus alone is harvested, quadrupled, and attached to 3 suspensory fixation devices in a Y-shaped configuration, creating a 4-stranded tibial limb and 2 double-stranded femoral limbs. A medial viewing/lateral working arthroscopic approach is adopted using specifically designed instrumentation. Anatomic placement of the 2 femoral tunnels is performed by a validated direct measurement technique. A single mid-bundle position is used on the tibia. Both femoral and tibial sockets are created in a retrograde manner using outside-to-in drilling. This is a simplified operative technique for anatomic double-bundle ACL reconstruction that maximizes bone preservation. The TriLink construct replicates the 2 bundles of the ACL, conferring native functional anisometry and improving femoral footprint coverage while avoiding the complexities and pitfalls of double–tibial tunnel techniques. Preservation of the gracilis reduces the morbidity of hamstring harvest and allows greater flexibility in graft choice in cases requiring multiligament reconstruction. PMID:24749016

Yasen, Sam K.; Logan, James S.; Smith, James O.; Nancoo, Tamara; Risebury, Mike J.; Wilson, Adrian J.

2013-01-01

125

[Peculiarities of early rehabilitation of mountain ski athletes after plastic reconstruction of anterior cruciate ligament].  

PubMed

The primary objective of the present study was to estimate the effectiveness of the new methods of physical rehabilitation for mountain ski athletes designed to optimize and accelerate restoration of their professional capabilities after arthroscopic plastic reconstruction of anterior cruciate ligament (ACL). This open controlled prospective study involved 26 alpine skiers aged from 18 to 25 who were recruited into the regular follow up program based at our Centre during the last 3 years. The athletes proved able to start balance training on the Biodex platform 4 weeks earlier than with the use of the conventional approach. These exercises were supplemented by the training of speed endurance on the Speed Courte tensor platform and Sky Teck ski simulators. Control studies were carried out on the 16th and 24th weeks of the rehabilitation period. Their results were compared with the results shown by the same athletes before injury. It was found that the early introduction of exercises designed to normalize proprioception into the rehabilitative treatment allowed the injured mountain ski athletes to restore the strength of femoral muscles and specific professional skills by the 4th month of the rehabilitation period. It is concluded that the combination of classical rehabilitative techniques with balance training, Speed Court training, and training on the alpine ski simulator makes it possible to begin special of alpine ski training on the snow 2 months earlier than with the use of conventkional methods. PMID:24137934

Sidorenko, E V; Preobrazhenski?, V Iu; Vnukov, D V; Preobrazhenskaia, M V

2013-01-01

126

Knee extension and flexion: MR delineation of normal and torn anterior cruciate ligaments  

SciTech Connect

Our goal was to assess the effect of joint position of semiflexed and extended knees in MR delineation of the anterior cruciate ligament (ACL). With a mobile knee brace and a flexible surface coil, the knee joint was either fully extended or bent to a semiflexed position (average 45{degrees} of flexion) within the magnet bore. Sets of oblique sagittal MR images were obtained for both extended and flexed knee positions. Thirty-two knees with intact ACLs and 43 knees with arthroscopically proven ACL tears were evaluated. Two observers compared paired MR images of both extended and flexed positions and rated them by a relative three point scale. Anatomic correlation in MR images was obtained by a cadaveric knee with incremental flexion. The MR images of flexed knees were more useful than of extended knees in 53% of the case reviews of femoral attachments and 36% of reviews of midportions of normal ACLs. Compared with knee extensions, the MR images for knee flexion provided better clarity in 48% of reviews of disrupted sites and 52% of residual bundles of torn ACLs. Normal ACL appeared taut in the knee extension and lax in semiflexion. Compared with MR images of knees in extension, MR images of knees in flexion more clearly delineate the femoral side of the ligament with wider space under the intercondylar roof and with decreased volume-averaging artifacts, providing superior visualization of normal and torn ACLs. 13 refs., 7 figs., 1 tab.

Niitsu, Mamoru; Ikeda, Kotaroh; Fukubayashi, Tohru; Anno, Izumi; Itai, Yuji [Univ. of Tsukuba, Ibaraki (Japan)] [Univ. of Tsukuba, Ibaraki (Japan)

1996-03-01

127

Evaluation of MRI Versus Arthroscopy in Anterior Cruciate Ligament and Meniscal Injuries  

PubMed Central

Aims and Objectives: To find out the incidence of ACL & meniscal injuries, to co-relate MRI findings with arthroscopy by calculating Sensitivity, Specificity, Positive And Negative Predictive Values (PPV & NPV) keeping arthroscopy as a gold standard, to find out the degree of subluxation and to grade it and to find a threshold value of fluid in knee. Settings and Design: Prospective analytical study. Materials and Methods: MRI of 230 patients with 71 arthroscopic co- relation in year 2012-14 was analysed. Statistical Analysis: Descriptive statistics using Chi square test and predictive values was done. The spearman correlation coefficient was done by using statistical software SPSS 17.0. Results: The sensitivity, specificity, PPV and NPV was calculated (in %). For ACL it was 87.87, 81.57, 80.55, 88.57 for MM 93.54, 87.50, 85.29, 94.59 and for LM 77.77, 81.81, 72.41, 85.71 respectively. We found 35.6% incidence of anterior tibial subluxation with maximum patients having grade 1 category subluxation. Two hundred and one cases showed joint fluid in lateral aspect of the suprapatellar pouch (AP diameter >10mm) with internal derangement. Conclusion: MRI is helpful in diagnosing meniscal and cruciate ligament injuries. Arthroscopy still remains gold standard for definitive diagnosis. PMID:25654007

Kashikar, Shivali Vaibhav; Lakhkar, Bhushan Narayan; Ahsan, Mohammad Saleem

2014-01-01

128

A Comparison of Anterior and Posterior Cruciate Ligament Laxity Between Female and Male Basketball Players.  

ERIC Educational Resources Information Center

The anterior cruciate ligament and posterior cruciate ligament laxity of 90 uninjured male and female high school players were measured. No significant differences were found, indicating that the greater female injury rate may be due to inadequate conditioning, not greater knee ligament laxity. (Author/MT)

Weesner, Carol L.; And Others

1986-01-01

129

Relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch: MRI and arthroscopy correlation  

Microsoft Academic Search

Objective  The purpose of this study was to evaluate the relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL)\\u000a and morphologic change of the intercondylar notch.\\u000a \\u000a \\u000a \\u000a Materials and methods  We retrospectively reviewed the 105 patients with knee magnetic resonance imaging (MRI) with or without knee arthroscopy [group\\u000a 1: patients with arthroscopic notchplasty (N?=?47), group 2: knee arthroscopy demonstrating intact ACL (N?=?33),

Ji Hyeon Cha; Sang Hoon Lee; Myung Jin Shin; Byeong Kyoo Choi; Sung Il Bin

2008-01-01

130

Osteomyelitis of the tibia following anterior cruciate ligament reconstruction  

PubMed Central

INTRODUCTION Osteomyelitis following anterior cruciate ligament (ACL) reconstruction is extremely rare. PRESENTATION OF CASE We present a thirty year old man who presented with pain in his proximal tibia six years after ACL reconstruction. Haematological investigations were normal. He was diagnosed with osteomyelitis of his proximal tibia. He was successfully treated with washout and debridement of his tibial tunnel. DISCUSSION This case highlights the need to exclude osteomyelitis as a late complication of ACL reconstruction in patients with proximal tibial pain. We also report on an unusual pathogen as casue of osteomyelitis. CONCLUSION Osteomyelitis in a tibial tunnel can present as a late complication of ACL reconstruction, even in the presence of normal haematological investigations. PMID:23274848

O’Neill, Barry J.; Molloy, Alan P.; McCarthy, Tom

2012-01-01

131

Arthroscopic studies of variants of the anterior horn of the medial meniscus  

Microsoft Academic Search

The objective of this study was to arthroscopically analyse the morphology and dynamics of variants of the anterior horn of the medial meniscus of the knee (VAMM) and to then consider the pathological significance of these variants. VAMM was defined as knees in which the anterior horn of the medial meniscus is not attached to the tibia. Between April 1992

Yasumitsu Ohkoshi; Tatsuto Takeuchi; Chiharu Inoue; Tomoyuki Hashimoto; Keiichi Shigenobu; Shigeru Yamane

1997-01-01

132

In-vivo Anterior Cruciate Ligament Elongation in Response to Axial Tibial Loads  

E-print Network

Background: The knowledge of in vivo anterior cruciate ligament (ACL) deformation is fundamental for understanding ACL injury mechanisms and for improving surgical reconstruction of the injured ACL. This study investigated ...

Gill, Thomas J.

133

Estimation of in-vivo forces within Anterior Cruciate Ligament in response to increased weightbearing  

E-print Network

The knowledge of Anterior Cruciate Ligament (ACL) forces in-vivo is instrumental for understanding ACL injury mechanisms and for improvement of surgical ACL reconstruction. The goal of this thesis was to develop and implement ...

Hosseini, Ali, M. Eng. Massachusetts Institute of Technology

2010-01-01

134

The use of hamstrings in anterior cruciate ligament reconstruction in patients over 40 years  

Microsoft Academic Search

Introduction  Anterior cruciate ligament reconstruction is an increasingly established method even in patients over 40 years old. Recent\\u000a studies with regard to this procedure used BTB transplants. We did a retrospective follow-up examination on over-40-year-old\\u000a patients with anterior cruciate ligament reconstruction using hamstring transplants and compared them to a younger control\\u000a group. Our hypothesis is that functional outcome after ACL-reconstruction is comparable

Bastian Marquass; Pierre Hepp; Thomas Engel; Thomas Düsing; Helmut Lill; Christoph Josten

2007-01-01

135

Anterior cruciate ligament injury in the athlete--an update in prevention strategies.  

PubMed

Anterior cruciate ligament (ACL) injuries are a common athletic injury. Athletes with this injury experience significant acute morbidity. These athletes are predisposed to the development of knee osteoarthritis with decreased knee quality of life. The public health implications of these injuries are profound. This article reviews the epidemiology of and risk factors for anterior cruciate ligament injuries in sports. The economic impact of these injuries is discussed. Effective strategies to prevent these significant knee injuries are presented. PMID:23189409

Peterson, Judith R; Peterson, Erik D

2012-11-01

136

Single versus Two-Incision Technique in Anterior Cruciate Ligament Replacement: Influence on Postoperative Muscle Function  

Microsoft Academic Search

The purpose of this study was to find out whether the single-incision technique for anterior cruciate ligament repair has advantages over the two-incision technique in terms of muscular function up to 1 year postoperatively. Twenty patients who underwent unilateral anterior cruciate ligament reconstruction with bone-patellar tendon-bone autografts were randomly assigned to one of the two procedures. Both groups (10 patients

Thomas Hess; Jochen Duchow; Stephan Roland; Dieter Kohn

2002-01-01

137

Acceleration of Tendon-Bone Healing of Anterior Cruciate Ligament Graft Using Autologous Ruptured Tissue  

Microsoft Academic Search

Background: It has been recently reported that human anterior cruciate ligament (ACL) ruptured tissue contains abundant vascular stem cells that contribute to tendon-bone healing in an immunodeficient rat model of ACL reconstruction.Hypothesis: Autologous ruptured ACL tissue has an effect on the maturation of bone-tendon integration in anterior cruciate ligament reconstruction.Study Design: Controlled laboratory study.Methods: Twenty healthy adult beagle dogs underwent

Tomoyuki Matsumoto; Seiji Kubo; Ken Sasaki; Yohei Kawakami; Shinya Oka; Hiroshi Sasaki; Koji Takayama; Katsumasa Tei; Takehiko Matsushita; Yutaka Mifune; Masahiro Kurosaka; Ryosuke Kuroda

2012-01-01

138

A modified repair for the anterior cruciate ligament deficient knee.  

PubMed Central

A retrospective analysis of 48 sportsmen and women from an original series of 76 consecutive patients who had undergone a modified McIntosh repair was carried out to establish whether or not the procedure could provide a satisfactory recovery and return to previous ability. The type and level of sport before injury was compared with that after operation. Symptoms of pain and giving way, and examination findings of pivot shift, and Lachman's test were compared before and after operation. Of the 48 patients assessed, 28 (58%) returned to full sporting capacity; 17 (35%) patients were participating in different sports or lower levels of their previous sports, and three patients did not participate in any sport. The more severely symptomatic knees did not perform so well after operation. The degree of preoperative anterior draw and Lachman's test did not influence the final result and the pivot shift, present in all before operation, was abolished in all but one case, which remained badly symptomatic. Concurrent meniscal injury or medial or lateral laxity did not influence return to sport once a full postoperative recovery was made. No deterioration was noticed in the level of sporting ability achieved thereafter. In this study it has been shown that the modified McIntosh repair is a swift extra-articular reconstruction for the anterior cruciate ligament deficient knee, which is less elaborate than previously described Ellison and McIntosh procedures, and which has produced a comparable result. PMID:1490218

Holland, J P

1992-01-01

139

Anterior Tibial Translation in Collegiate Athletes with Normal Anterior Cruciate Ligament Integrity  

PubMed Central

Objective: To examine differences in anterior tibial translation (ATT) among sports, sex, and leg dominance in collegiate athletes with normal anterior cruciate ligament integrity. Design and Setting: Subjects from various athletic teams were measured for ATT in right and left knees. Subjects: Sixty subjects were measured for ATT with a KT-1000 knee arthrometer. Measurements: Statistical analyses were computed for each sex and included a 2 × 3 × 4 mixed-factorial analysis of variance (ANOVA) for anterior cruciate ligament displacement, right and left sides, and force and sport. A 2 × 2 × 3 mixed-factorial ANOVA was computed to compare means for sex and force. A 2 × 3 mixed-factorial ANOVA was computed to compare sex differences across 3 forces. Results: For males and females, no significant interactions were found among leg, force, and sport for mean ATT, for leg and sport or leg and force, or for translation values between dominant and nondominant legs. Males had a significant interaction for force and sport, and a significant difference was found for side of body, since the right side had less translation than the left side. Females had greater ATT than males at all forces. Conclusions: Sex differences exist for ATT, and differences in ATT exist among sports for both sexes. Differences between the right and left sides of the body should be expected when making comparisons of ligamentous laxity. ImagesFigure 2.Figure 3.Figure 5. PMID:16558565

Rosene, John M.; Fogarty, Tracey D.

1999-01-01

140

Prospective Comparative Study of Anterior Cruciate Ligament Reconstruction Using the Double-Bundle and Single-Bundle Techniques  

Microsoft Academic Search

Background: The intent of double-bundle anterior cruciate ligament reconstruction is to reproduce the normal anterior cruciate ligament anatomy and improve knee joint rotational stability. However, no consensus has been reached on the advantages of this technique over the single-bundle technique.Hypothesis: We hypothesized that double-bundle anterior cruciate ligament reconstruction could provide better intraoperative stability and clinical outcome than single-bundle reconstruction.Type of

Eun Kyoo Song; Luke S. Oh; Thomas J. Gill; Guoan Li; Hemanth R. Gadikota; Jong Keun Seon

2009-01-01

141

The mid- to long-term results of the anterior cruciate ligament reconstruction with hamstring tendons using Transfix technique  

Microsoft Academic Search

In this study, mid to long-term results of anterior cruciate ligament reconstruction with hamstring tendons and Transfix technique\\u000a were evaluated. Anterior cruciate ligament (ACL) reconstruction with four-strand hamstring tendon was performed with Transfix\\u000a technique on 271 (198 males, 73 females; mean age 25.7; 17–52) patients with anterior cruciate ligament ruptures. The patients\\u000a were followed up with clinical examination, Lysholm and

Mehmet Asik; Cengiz Sen; Ibrahim Tuncay; Mehmet Erdil; Cem Avci; Omer F. Taser

2007-01-01

142

Anterior Cruciate Ligament Injury Patterns Among Collegiate Men and Women  

PubMed Central

Objective: To determine potential patterns that cause males and females to tear the anterior cruciate ligament (ACL) while playing basketball or soccer. Design and Setting: We reviewed data submitted to the National Collegiate Athletic Association Injury Surveillance System over the last 10 years, as well as profile data collected from collegiate certified athletic trainers. Subjects: College athletes involved in basketball or soccer. Measurements: Historical information was collected on those athletes involved in the National Collegiate Athletic Association Injury Surveillance System. Athletes involved in the profiling study underwent physical measurements related to flexibility, as well as a more detailed history relating to the ACL tear. Results: College-age women involved in basketball or soccer tear their ACLs at significantly higher rates than college-age men involved in the same sports. No distinct physical or historical measurements could be attributed to this different rate of injury. Conclusions: Although the higher rate at which women compared with men tear their ACLs has persisted over the last 10 years, this increased incidence is not clearly attributable to any physical or historical measurements that were monitored. PMID:16558564

Arendt, Elizabeth A.; Agel, Julie; Dick, Randall

1999-01-01

143

Tracking Patient Outcomes after Anterior Cruciate Ligament Reconstruction  

PubMed Central

ABSTRACT Purpose: To model how patients' knee range of motion (ROM), pain, and self-reported lower-extremity (LE) functional status change over the first 26 weeks following anterior cruciate ligament (ACL) reconstruction and to estimate the test–retest reliability of these measurements. Methods: Patients were assessed weekly over 26 weeks following ACL reconstruction. Outcomes were knee ROM, LE functional status measured by the Lower Extremity Functional Scale (LEFS), and pain measured by the 4-item pain intensity measure (P4). A nonlinear model was applied to describe change for each outcome. Intra-class correlation coefficients and standard errors of measurement were applied to estimate test-retest reliability and minimal detectable change. Results: A nonlinear model provided the following model fit values (R2): P4=0.71, extension ROM=0.51, flexion ROM=0.99, LEFS=0.97. For pain and ROM, the limit values were reached by approximately 12 weeks after reconstruction; LEFS values continued to increase up to 26 weeks. Test-retest reliability coefficients varied from 0.85 to 0.95. Conclusions: The greatest improvement occurred in the first 8 weeks after surgery. Recovery was nearly complete by 12 weeks with respect to pain and ROM, although LE functional status continued to improve throughout the study period. Scores on all measures demonstrated reliability, which supports their use with individual patients. PMID:24799759

Peterson, Devin; Sutherland, Melanie Stevens; Ayeni, Olufemi; Stratford, Paul W.

2014-01-01

144

Ruptures of the anterior cruciate ligament in soccer.  

PubMed

Ruptures of the anterior cruciate ligament (ACL) are serious, common and costly injuries. The present 12-year investigation was undertaken to examine the frequency of ACL ruptures and identify the game events that may have contributed to the cause of these injuries in male soccer players across a French district. A retrospective questionnaire was used to record the players' age at the time of injury, laterality, standard of play, playing position and injured side. The characteristics of the injury situations were described in detail to investigate the game events involved in each case. A total of 934 ruptures was reported. Significantly more ruptures were sustained in a non-contact versus a contact situation (p<0.01). Of the total number of lesions, 34.5% occurred during a pivot action. The right knee was affected more than the left knee (p<0.001), irrespective of the dominant side of the player. Certain game events reported in the injury situations were shown to be related to player's age, standard and position. While these results have confirmed observations from previous investigations on ACL ruptures in soccer, the analysis of a considerably larger number of injury cases has brought new findings to the literature as well as recommendations for future research. PMID:19199222

Rochcongar, P; Laboute, E; Jan, J; Carling, C

2009-05-01

145

Bioabsorbable expansion bolt fixation in anterior cruciate ligament reconstruction.  

PubMed

The current study evaluated initial fixation strength of a bioabsorbable expansion bolt compared with interference screw fixation in anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Thirty calf tibial plateaus with adjacent patella and extensor ligaments were used. Bioabsorbable poly-L-lactide interference screws were used for graft fixation in Group I, titanium screws in Group II, and bioabsorbable poly-DL-lactide expansion bolts were used in Group III. The mean force-to-failure (+/- standard deviation) in the three groups was 487 +/- 205 N, 713 +/- 218 N, and 594 +/- 224 N, respectively. The differences between Groups I and II were significant. No statistical differences were found regarding stiffness. Graft damage was significantly less in Group III compared with screw fixation. The fixation concept of an expansion bolt shows similar fixation strength and less graft damage compared with the established interference screw fixation. Because of the total absence of torque forces in contrast to bioabsorbable screws, the risk of implant breakage is minimized. PMID:15043122

Piltz, S; Steinbauer, T; Meyer, L; Plitz, W; Andress, H J; Lob, G

2004-01-01

146

Anterior cruciate ligament allograft transplantation for intraarticular ligamentous reconstruction.  

PubMed

A multiplicity of surgical operations have been developed in an attempt to achieve satisfactory function after anterior cruciate ligament (ACL) repair. None of these procedures have been able to reproduce the fiber organization anatomy of attachment site, vascularity, or function of the ACL. Twenty-nine foxhounds received a deep-frozen bone-ACL-bone allograft and a ligament augmentation device (LAD). Biomechanical, microvascular, and histological changes were evaluated 3, 6, and 12 months following implantation. The maximum loads of the allograft/LADs were 34.3% (387.2 N) after 3 months, 49.3% (556.6 N) after 6 months, and 61.1% (698.8 N) after a year. The maximum load was 69.1% (780 N). In general, after 6 months the allografts showed normal collagen orientation. The allografts demonstrated no evidence of infection or immune reaction. No bone ingrowth into the LAD was observed. Polarized light microscopy and periodic acid-schiff staining showed that the new bone-ligament substance interface had intact fiber orientation at the area of the ligament insertion. Microvascular examination using the Spalteholtz technique revealed revascularization and the importance of an infrapatellar fat pad for the nourishment of ACL allografts. PMID:1389780

Goertzen, M; Dellmann, A; Gruber, J; Clahsen, H; Bürrig, K F

1992-01-01

147

Teaching of anterior cruciate ligament function in osteopathic medical education.  

PubMed

The anterior cruciate ligament (ACL) of the knee and the function of its anteromedial (AM) and posterolateral (PL) bundles are a focus of orthopedic research. Because of the probability that third-year and fourth-year osteopathic medical students will encounter ACL injuries during clinical rotations, it is of paramount importance that students fully understand the functions of the AM and PL bundles as 2 distinct functional components of the ACL. The authors assess the degree to which the AM and PL bundles are discussed within basic science curricula at colleges of osteopathic medicine (COMs). In September 2008, a 6-question survey addressing various aspects of ACL education was mailed to instructors of lower-extremity anatomy at all 28 COMs that existed at that time. Nine of the 21 responding institutions (42.9%) indicated that both the AM and PL bundles of the ACL are discussed within their basic science curricula. Four of these 9 COMs indicated that their instruction mentions that the bundles are parallel in extension and crossed in flexion. Nine of the 21 responding COMs (42.9%) indicated that they instruct students that the AM bundle is a major anterior-posterior restrictor, and 12 (57.1%) indicated that they instruct students that the PL bundle is the major rotational stabilizer of the ACL. In 7 of the 21 responding COMs (33.3%), the AM and PL bundles are identified via direct visualization during anatomic dissection of the ACL. The authors conclude that their findings suggest the need for enhanced presentation of the AM and PL bundles within the basic science curricula at COMs to provide osteopathic medical students with a more comprehensive education in anatomy. PMID:21562291

Surek, Christopher Chase; Lorimer, Shannon D; Dougherty, John J; Stephens, Robert E

2011-04-01

148

Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads  

Microsoft Academic Search

The anterior cruciate ligament (ACL) can be anatomically divided into anteromedial (AM) and posterolateral (PL) bundles. Current ACL reconstruction techniques focus primarily on reproducing the AM bundle, but are insufficient in response to rotatory loads. The objective of this study was to determine the distribution of in situ force between the two bundles when the knee is subjected to anterior

Mary T. Gabriel; Eric K. Wong; Savio L. Y. Woo; Masayoshi Yagi; Richard E. Debski

2004-01-01

149

ORV Arthroscopic Reduction and Internal Fixation of Tibial Eminence Fractures  

PubMed Central

Tibial eminence fractures are an uncommon but well-described avulsion of the anterior cruciate ligament. Treatment principles are based on the amount and pattern of fracture displacement. Management has evolved from closed reduction and immobilization to arthroscopic reduction and internal fixation followed by early rehabilitation. Various fixation methods have evolved, ranging from arthroscopic reduction and percutaneous screw fixation to arthroscopic suture repair. We present a technique for arthroscopic reduction and internal fixation using a cannulated drill bit and high-strength suture. This technique facilitates anatomic reduction with uncomplicated tunnel placement and suture passing in an effort to allow strong fixation and early rehabilitation. PMID:24400179

Myer, Daniel M.; Purnell, Gregory J.; Caldwell, Paul E.; Pearson, Sara E.

2013-01-01

150

Can we use peroneus longus in addition to hamstring tendons for anterior cruciate ligament reconstruction?  

PubMed Central

Background: The aim of this study is to evaluate the possible effects of removing the peroneus longus on the ankle and gait parameters, in order to add insufficient hamstring tendons for anterior cruciate ligament (ACL) reconstruction. Materials and Methods: In this controlled clinical trial, 375 patients with ACL rupture who underwent ACL reconstruction arthroscopically using hamstring tendons in the orthopedic clinics of Isfahan University of Medical Sciences in 2010 and 2011 were selected. Fifteen patients were included because their hamstring tendon diameter was lower than 8 mm and peroneus longus was added. After 6 months, the patients were followed using “Kistler force plate” to detect 3D kinematics and kinetics of the ankles and spatiotemporal walking parameters. Results: There was a significant difference between both operated and non-operated ankles in flexion/extension range of motion (P < 0.05). There was no significant difference between the moments of both ankles in sagittal and coronal planes (P > 0.05), but there was a significant difference between the moments of both ankles in the transverse plane (P = 0.006). There was a significant difference in the force of operated and non-operated ankles in all three planes (P < 0.05). There was no significant difference in the mean values of spatiotemporal gait parameters between operated and non-operated sides (P > 0.05). Conclusion: Removing the peroneus longus tendon has no effect on gait parameters and does not lead to instability of the ankle. So, it can be used as an autogenous graft in orthopedic surgeries. PMID:24949286

Nazem, Khalilallah; Barzegar, Mohammadreza; Hosseini, Alireza; Karimi, Mohammadtaghi

2014-01-01

151

Anterior Cruciate Ligament Injuries in Female AthletesPart 2, A Meta-analysis of Neuromuscular Interventions Aimed at Injury Prevention  

Microsoft Academic Search

Female athletes have a 4 to 6 times higher incidence of anterior cruciate ligament injury than do male athletes participating in the same landing and pivoting sports. This greater risk of anterior cruciate ligament injury, coupled with a geometric increase in participation (doubling each decade), has led to a significant rise in anterior cruciate ligament injuries in female athletes. The

Timothy E. Hewett; Kevin R. Ford; Gregory D. Myer

2006-01-01

152

Intraoperative evaluation of anteroposterior and rotational stabilities in anterior cruciate ligament reconstruction: lower femoral tunnel placed single-bundle versus double-bundle reconstruction.  

PubMed

Twenty-six patients with anteroposterior (AP) laxity of the knee, associated with torn anterior cruciate ligament (ACL), were prospectively randomized for arthroscopic lower femoral tunnel placed single- or double-bundle reconstruction using hamstring tendons. We evaluated AP and rotational stabilities under regular loads (a 100-N anterior load and a 1.5-N m external-internal load) before and after ACL reconstruction, comparing single- and double-bundle reconstruction with our original device for applying quantitative tibial rotation and the navigation system intraoperatively. No significant differences were found between the two groups in AP displacement and total range of tibial rotation at 30 degrees and 60 degrees of knee flexion. We found that a lower femoral tunnel placed single-bundle reconstruction reproduced AP and rotational stability as well as double-bundle reconstruction after reconstruction intraoperatively. PMID:19263035

Kanaya, Atsushi; Ochi, Mitsuo; Deie, Masataka; Adachi, Nobuo; Nishimori, Makoto; Nakamae, Atsuo

2009-08-01

153

Gait Asymmetries Persist 1 Year After Anterior Cruciate Ligament Reconstruction  

PubMed Central

Background After anterior cruciate ligament reconstruction (ACLR), motivation to return to previous levels of activity is high. Very few studies have used return-to-activity criteria to determine when to permit athletic play. Return-to-activity measures objectively evaluate functional limb symmetry; however, previous biomechanical studies have found gait deviations in these individuals that persist up to 2 years after surgery. Purpose To evaluate gait biomechanics in a specific cohort of ACL patients 1 year after surgery and retrospectively compare individuals who pass return-to-activity criteria 6 months after surgery with those who fail. Study Design Prospective analysis. Methods A total of 40 athletes who participated regularly (>50 h/y) in cutting, jumping, and pivoting activities and who sustained an isolated, unilateral ACL rupture were included in this study. All participants underwent reconstruction by the same surgeon and received individualized postoperative rehabilitation. Performance-based and self-report data were measured 6 months after surgery to assess readiness to return to activity (90% outcome required to pass); 20 subjects passed return-to-activity criteria and 20 subjects did not. Motion analysis was performed 1 year after surgery, and knee flexion angles, moments, and excursions were measured during gait and evaluated for all subjects. Results There was no limb × group interaction or effect of group for all measures. Decreased knee measures were seen on the involved limb compared with the uninvolved limb for all subjects, and failed subjects demonstrated larger differences between limbs. Conclusion Patients continued to demonstrate biomechanical limb asymmetries 1 year after ACLR, regardless of performance-based measures at 6 months. Early return to activity did not ensure limb symmetry at 1 year. Clinical Relevance Gait asymmetries were seen in all subjects 1 year after surgery regardless of status at 6 months. Potentially prolonging athlete’s timelines for returning to activity may prove beneficial for a successful return to activity as well as for long-term knee function. PMID:25685823

White, Kathleen; Logerstedt, David; Snyder-Mackler, Lynn

2015-01-01

154

Long Term Gait Deviations in Anterior Cruciate Ligament Reconstructed Females  

PubMed Central

Purpose Little is known of the potential long term gait alterations that occur after an anterior cruciate ligament (ACL) reconstruction. In particular, variables such as impact loading which have been previously associated with joint deterioration have not been studied in walking and running after an ACL reconstruction. The purpose of this study was to define the alterations in impact forces, loading rates, and the accompanying sagittal plane kinematic and kinetic mechanics at the time of impact between the ACL reconstructed group and a healthy control group. Methods 40 females (20 ACL reconstruction, 20 controls) participated in the study. An instrumented gait analysis was performed on all subjects. Between group and limb comparisons were made for initial vertical impact force, loading rate, sagittal plane knee and hip angles as well as moments. Results During walking and running the ACL cohort had significantly greater initial vertical impact force (p=0.002 and p= 0.001), and loading rates (p=0.03 and p= 0.01), as well as a smaller knee extensor moment and hip angle during walking (p=0.000 and p=0.01). There was a trend towards a smaller knee moment and hip angle during running (p=0.08 and p=0.06) as well as a larger hip extensor moment during walking (p=0.06) in the ACL group. No differences were found for hip extensor moment during running, knee angles between groups during walking or running. Lastly, no between limb differences were found for any variable. Conclusion Gait deviations such as elevated impact loading and loading rates do not resolve long term after the individual has resumed previous activity levels and may contribute to the greater risk of early joint degeneration in this population. PMID:23568090

Noehren, Brian; Wilson, Hilary; Miller, Casey; Lattermann, Christian

2015-01-01

155

Outcome of chronic isolated anterior cruciate ligament reconstruction.  

PubMed

The aim of the article is to identify demographic and intraoperative factors that predict patient-oriented outcomes as measured by knee-specific and general quality of life (QoL) questionnaires for chronic, unilateral primary anterior cruciate ligament (ACL) tears following surgical reconstruction. A total of 69 patients were prospectively evaluated using the Medical Outcomes Study 36-item Short Form (SF-36), modified Lysholm, Tegner activity level, and subjective portion of the International Knee Documentation Committee (IKDC) questionnaires. The surveys were administered preoperatively and postoperatively with a minimum 2-year follow up. Efficacy of treatment was evaluated by comparing preoperative and postoperative questionnaire scores. Multivariate linear regression analysis was used to identify demographic and intraoperative variables that were independent predictors of outcome. At a minimum 2-year follow-up (mean, 3.6 years), 55 of 69 patients (80%) were available for follow-up. There were statistically significant improvements in the Lysholm, Tegner, and subjective portion of the IKDC, as well as several SF-36 domains that measure physical capabilities (p?

McAllister, David R; Foster, Brock; Martin, Daniel E; Veitch, Andrew J; Dorey, Frederick J; Petrigliano, Frank; Hame, Sharon L

2014-10-01

156

Autograft Versus Nonirradiated Allograft Tissue for Anterior Cruciate Ligament Reconstruction  

PubMed Central

Background An autograft has traditionally been the gold standard for anterior cruciate ligament reconstruction (ACLR), but the use of allograft tissue has increased in recent years. While numerous studies have demonstrated that irradiated allografts are associated with increased failure rates, some report excellent results after ACLR with nonirradiated allografts. The purpose of this systematic review was to determine whether the use of nonirradiated allograft tissue is associated with poorer outcomes when compared with autografts. Hypothesis Patients undergoing ACLR with autografts versus nonirradiated allografts will demonstrate no significant differences in graft failure risk, laxity on postoperative physical examination, or differences in patient-oriented outcome scores. Study Design Systematic review. Methods A systematic review was performed to identify prospective or retrospective comparative studies (evidence level 1, 2, or 3) of autografts versus nonirradiated allografts for ACLR. Outcome data included graft failure based on clinical findings and instrumented laxity, postoperative laxity on physical examination, and patient-reported outcome scores. Studies were excluded if they did not specify whether the allograft had been irradiated. Quality assessment and data extraction were performed by 2 examiners. Results Nine studies comparing autografts and nonirradiated allografts were included. Six of the 9 studies compared bone– patellar tendon–bone (BPTB) autografts with BPTB allografts. Two studies compared hamstring tendon autografts to hamstring tendon allografts, and 1 study compared hamstring tendon autografts to tibialis anterior allografts. The mean patient age in 7 of 9 studies ranged from 24.5 to 32 years, with 1 study including only patients older than 40 years and another not reporting patient age. The mean follow-up duration was 24 to 94 months. Six of 9 studies reported clinical graft failure rates, 8 of 9 reported postoperative instrumented laxity measurements, 7 of 9 reported postoperative physical examination findings, and all studies reported patient-reported outcome scores. This review demonstrated no statistically significant difference between autografts and nonir-radiated allografts in any outcome measure. Conclusion No significant differences were found in graft failure rate, postoperative laxity, or patient-reported outcome scores when comparing ACLR with autografts to nonirradiated allografts in this systematic review. These findings apply to patients in their late 20s and early 30s. Caution is advised when considering extrapolation of these findings to younger, more active cohorts. PMID:23928319

Mariscalco, Michael W.; Magnussen, Robert A.; Mehta, Divyesh; Hewett, Timothy E.; Flanigan, David C.; Kaeding, Christopher C.

2014-01-01

157

Preparing a female collegiate athlete for anterior cruciate ligament reconstruction and rehabilitation.  

PubMed

An anterior cruciate ligament injury is common among athletes involved in sports where cutting or sudden changes of position occur. This is a case study of a female collegiate athlete who sustained an anterior cruciate ligament injury, with a small meniscus tear, and decides on a course of surgery. Questions she has about the initial injury, as well as subsequent questions concerning reconstructive surgery using a patellar graft and the course of rehabilitation, are answered. A chart of her rehabilitation protocol is provided. PMID:12803146

Leech, Edward

2003-01-01

158

Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects: A Cross-sectional Study  

PubMed Central

[Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint position sense in a manner relevant to the mechanism of injury. Therefore, the aim of this study was to measure knee joint position sense in the noncontact anterior cruciate ligament injury risk position and normal condition. [Subjects and Methods] Thirty healthy male athletes participated in the study. Joint position sense was evaluated by active reproduction of the anterior cruciate ligament injury risk position and normal condition. The dominant knees of subjects were tested. [Results] The results showed less accurate knee joint position sense in the noncontact anterior cruciate ligament injury risk position rather than the normal condition. [Conclusion] The poorer joint position sense in non-contact anterior cruciate ligament injury risk position compared with the normal condition may contribute to the increased incidence of anterior cruciate ligament injury. PMID:25364100

Mir, Seyed Mohsen; Talebian, Saeed; Naseri, Nasrin; Hadian, Mohammad-Reza

2014-01-01

159

The Mechanistic Connection Between the Trunk, Knee, and Anterior Cruciate Ligament Injury  

PubMed Central

Neuromuscular control of the trunk and knee predicts anterior cruciate ligament injury risk with high sensitivity and specificity. These predictors are linked, as lateral trunk positioning creates high knee abduction torque (load). The hypotheses explored are that lateral trunk motion increases load and that neuromuscular training that increases trunk control will decrease load. PMID:21799427

Hewett, Timothy E.; Myer, Gregory D.

2014-01-01

160

Injury Mechanisms for Anterior Cruciate Ligament Injuries in Team Handball A Systematic Video Analysis  

Microsoft Academic Search

Results: Two main injury mechanisms for anterior cruciate ligament injuries in team handball were identified. The most common (12 of 20 injuries), a plant-and-cut movement, occurred in every case with a forceful valgus and external or internal rotation with the knee close to full extension. The other main injury mechanism (4 of 20 injuries), a 1-legged jump shot landing, occurred

Odd-Egil Olsen; Grethe Myklebust; Lars Engebretsen; Roald Bahr

161

An in vivo strain gage study of elongation of the anterior cruciate ligament  

Microsoft Academic Search

The purpose of this paper is to study the load-elonga tion characteristics of a Grade II sprain of the anterior cruciate ligament (ACL) at the time of local anesthesia arthroscopy. The data may be used to increase diag nostic and prognostic accuracy when evaluating Grade II ACL sprains and to structure properly a rehabilitation program following ACL injury.This report is

Charles E. Henning; Mary A. Lynch; Karl R. Glick

1985-01-01

162

Magnetic resonance imagination of the peroneus longus tendon after anterior cruciate ligament reconstruction.  

PubMed

Several studies report that tendons can regenerate after harvesting. These studies have been performed especially in patellar and hamstring tendons. At our institution, 10 cm length of full thickness peroneus longus tendon has been harvested to reconstruct torn anterior cruciate ligament since 1997 as a different graft source. The aim of this study was to investigate whether the peroneus longus tendon used the anterior cruciate ligament reconstruction has a regeneration potential or not. Twelve patients, who had originally undergone harvesting of the peroneus longus tendon for the primary surgery of the anterior cruciate ligament reconstruction, underwent magnetic resonance imaging (MRI). Images of both legs were acquired simultaneously with the use of the scanner's extremity coil, as we aimed to compare harvested peroneus longus tendon with the other leg's peroneus longus tendon (healthy side) for evaluation of the regeneration potential. The average age of the patients was 31 years. There were eight right and four left legs. The average time interval was 52 months between ligament surgery and MRI. In all patients, a varying amount of the regeneration of the peroneus longus tendon was seen on the MRI images. Although the extent of PLT regeneration in proximal sections seemed better than in mid- and distal sections, there was no statistical difference between sections (P = 0.130). These data show that the peroneus longus tendon has a regeneration potential after harvesting for anterior cruciate ligament reconstruction. PMID:18818901

Kerimo?lu, Servet; Ko?ucu, Polat; Livao?lu, Murat; Yükünç, Ismail; Turhan, Ahmet U?ur

2009-01-01

163

Postural sway and balance testing: a comparison of normal and anterior cruciate ligament deficient knees  

Microsoft Academic Search

The purpose of this study was to assess postural sway and balance in normal and anterior cruciate ligament (ACL) deficient (ACLD) knees. Performance was assessed in 15 ACLD and 15 matched control (CON) subjects whilst standing on a postural sway meter and on a balance board. On both pieces of apparatus subjects attempted to maintain balance for 30 s under

Mary O'Connell; Keith George; David Stock

1998-01-01

164

The relationship between knee strength and functional stability before and after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Functional stability of the knee is dependent on an intact ligamentous system and the timely and efficient contraction of supporting musculature. The aim of this study was to assess the relationship between muscle strength and functional stability in 31 patients pre- and post-operatively, following a unilateral anterior cruciate ligament rupture. All subjects underwent reconstructive surgery using semitendonosis and gracilis tendons.

S. L. Keays; J. E. Bullock-Saxton; P. Newcombe; A. C. Keays

2003-01-01

165

In vivo anterior cruciate ligament strain behaviour during a rapid deceleration movement: case report  

Microsoft Academic Search

The mechanism of anterior cruciate ligament (ACL) injury is still unclear. To gain this insight, knowledge of the mechanical behaviour of the healthy ACL during activities that may stress the ligament must be investigated in vivo. The goal of this research was to measure ACL strain in vivo during rapid deceleration, a sport type movement that has been previously shown

G. Cerulli; D. L. Benoit; M. Lamontagne; A. Caraffa; A. Liti

2003-01-01

166

Anterior Cruciate Ligament Reconstruction and Preservation: The Single-Anteromedial Bundle Biological Augmentation (SAMBBA) Technique.  

PubMed

Preservation of the anterior cruciate ligament (ACL) remnant during ACL reconstruction has the advantages of improved vascularity and synovial encircling of the graft tendon. We describe a technique called single-anteromedial bundle biological augmentation (SAMBBA) using complete preservation of the ACL remnant, as well as preservation of the semitendinosus tibial insertion, that uses standard portals and equipment. PMID:25685675

Sonnery-Cottet, Bertrand; Freychet, Benjamin; Murphy, Colin G; Pupim, Barbara H B; Thaunat, Mathieu

2014-12-01

167

Implementation of Open and Closed Kinetic Chain Quadriceps Strengthening Exercises after Anterior Cruciate Ligament Reconstruction.  

ERIC Educational Resources Information Center

Reviews the effects of open kinetic chain (OKC) and closed kinetic chain (CKC) exercise on anterior cruciate ligament (ACL) strain and patellofemoral joint stress, suggesting a combination of the two for quadriceps strengthening after ACL reconstruction. Both OKC and CKC exercises may be modified and implemented for quadriceps strengthening after…

Ross, Michael D.; Denegar, Craig R.; Winzenried, Jay A.

2001-01-01

168

Early histologic, metabolic, and vascular assessment of anterior cruciate ligament autografts  

SciTech Connect

A rabbit model for anterior cruciate ligament (ACL) reconstruction using autogenous patellar tendon was utilized to study the early events of autograft cellular dynamics. Biochemical, autoradiographic, histological, and vascular injection techniques demonstrated that the native autograft cell population rapidly necroses. This repopulation occurs without a vascular contribution; cells entering the autograft are reliant upon synovial fluid nutrition.

Kleiner, J.B.; Amiel, D.; Harwood, F.L.; Akeson, W.H.

1989-01-01

169

Training for Women's Basketball: A Biomechanical Emphasis for Preventing Anterior Cruciate Ligament Injury.  

ERIC Educational Resources Information Center

Summarizes proposed variables linked with higher incidences of anterior cruciate ligament tears in females and the biomechanical aspects of the lower extremity during the performance of common basketball skills, focusing on gender differences in knee joint stability and neuromuscular control, biomechanical aspects of lower extremity skills in…

Pettitt, Robert W.; Bryson, Erin R.

2002-01-01

170

Acute repair of injury to the anterior cruciate ligamentA long-term followup  

Microsoft Academic Search

We reviewed 30 patients at an average of 7.4 years after acute repair of the anterior cruciate ligament aug mented with a loop of iliotibial tract. A noncontact twisting had been the mechanism of injury in 18 of these patients, with 28 having been injured in sports. At followup, 25 patients had not experienced symptoms of instability and 23 were

Mervyn J. Cross; J. R. Wootton; Desmond J. Bokor; Sam J. Sorrenti

1993-01-01

171

Retear of anterior cruciate ligament grafts in female basketball players: a case series  

Microsoft Academic Search

BACKGROUND: Incidence of anterior cruciate ligament (ACL) injuries in young female basketball players is higher than that in male basketball players. Graft retears are more frequent with the increasing number of ACL reconstructions. The present study aimed to examine the incidence of retears in competitive female basketball players. METHODS: Sixty-four female basketball players (aged 12 to 29 years) who underwent

Yoshinari Tanaka; Yasukazu Yonetani; Yoshiki Shiozaki; Takuya Kitaguchi; Nozomi Sato; Shinya Takeshita; Shuji Horibe

2010-01-01

172

An Anterior Cruciate Ligament Injury Prevention Framework: Incorporating the Recent Evidence  

Microsoft Academic Search

Anterior cruciate ligament (ACL) injury rates have increased by ?50% over the last 10 years. These figures suggest that ACL focused research has not been effective in reducing injury rates among community level athletes. Training protocols designed to reduce ACL injury rates have been both effective (n?=?3) and ineffective (n?=?7). Although a rationale for the use of exercise to reduce

C. J. Donnelly; B. C. Elliott; T. R. Ackland; T. L. A. Doyle; T. F. Beiser; C. F. Finch; J. L. Cochrane; A. R. Dempsey; D. G. Lloyd

2012-01-01

173

Proprioceptive training and prevention of anterior cruciate ligament injuries in soccer.  

PubMed

This commentary describes a program developed to help reduce the incidence of anterior cruciate ligament injuries in soccer players. The basic principles underlying the injury prevention protocol are described with respect to the proprioceptive control mechanisms at the knee joint. This is followed by a detailed description of the program. PMID:11720298

Cerulli, G; Benoit, D L; Caraffa, A; Ponteggia, F

2001-11-01

174

An Evaluation Method of EndoButton Position in MDCT Image After Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Anterior Cruciate Ligament (ACL) reconstruction is performed to recover the injured knee which often happens in sports activity such as skiing, and basketball. The ACL reconstruction makes two bone tunnels in the femur and tibia. Then, the harvested graft passes the bone tunnels so that the femur and tibia are connected. The graft is fixed to the femur by using

Kouki Nagamune; Daisuke Arake; Koji Nishimot; Yuichi Hoshino; Seiji Kubo; Ryosuke Kuroda; Mashiro Kurosaka

2009-01-01

175

In vivo study of anterior cruciate ligament regeneration using mesenchymal stem cells and silk scaffold  

Microsoft Academic Search

Although most in vitro studies indicate that silk is a suitable biomaterial for ligament tissue engineering, in vivo studies of implanted silk scaffolds for ligament reconstruction are still lacking. The objective of this study is to investigate anterior cruciate ligament (ACL) regeneration using mesenchymal stem cells (MSCs) and silk scaffold. The scaffold was fabricated by incorporating microporous silk sponges into

Hongbin Fan; Haifeng Liu; Eugene J. W. Wong; Siew L. Toh; James C. H. Goh

2008-01-01

176

Anterior cruciate ligament regeneration using mesenchymal stem cells and silk scaffold in large animal model  

Microsoft Academic Search

Although in vivo studies in small animal model show the ligament regeneration by implanting mesenchymal stem cells (MSCs) and silk scaffold, large animal studies are still needed to evaluate the silk scaffold before starting a clinical trial. The aim of this study is to regenerate anterior cruciate ligament (ACL) in pig model. The micro-porous silk mesh was fabricated by incorporating

Hongbin Fan; Haifeng Liu; Siew L. Toh; James C. H. Goh

2009-01-01

177

Femoral tunnel placement in anterior cruciate ligament reconstruction: rationale of the two incision technique  

Microsoft Academic Search

Endoscopic anterior cruciate ligament (ACL) reconstruction can be performed through one-incision or two-incision technique. The current one-incision endoscopic ACL single bundle reconstruction techniques attempt to perform an isometric repair placing the graft along the roof of the intercondylar notch, anterior and superior to the native ACL insertion. However the ACL isometry is a theoretical condition, and has not stood up

Raffaele Garofalo; Biagio Moretti; Cyril Kombot; Lorenzo Moretti; Elyazid Mouhsine

2007-01-01

178

Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model  

Microsoft Academic Search

Anterior cruciate ligament (ACL) graft impingement against the intercondylar roof has been postulated, but not thoroughly\\u000a investigated. The roof impingement pressure changes with different tibial and femoral tunnel positions in ACL reconstruction.\\u000a Anterior tibial translation is also affected by the tunnel positions of ACL reconstruction. The study design included a controlled\\u000a laboratory study. In 15 pig knees, the impingement pressure

Takanori Iriuchishima; Goro Tajima; Sheila J. M. Ingham; Wei Shen; Takashi Horaguchi; Akiyoshi Saito; Patrick Smolinski; Freddie H. Fu

2009-01-01

179

The effect of weightbearing and external loading on anterior cruciate ligament strain  

Microsoft Academic Search

A force balance between the ligaments, articular contact, muscles and body weight maintains knee joint stability. Thus, it is important to study anterior cruciate ligament (ACL) biomechanics, in vivo, under weightbearing conditions. Our objective was to compare the ACL strain response under weightbearing and non-weightbearing conditions and in combination with three externally applied loadings: (1) anterior–posterior shear forces, (2) internal–external

Braden C Fleming; Per A Renstrom; Bruce D Beynnon; Bjorn Engstrom; Glenn D Peura; Gary J Badger; Robert J Johnson

2001-01-01

180

An unusual epidemic of Staphylococcus-negative infections involving anterior cruciate ligament reconstruction with salvage of the graft and function.  

PubMed

We performed a retrospective study of 13 patients who had postoperative clinical and laboratory signs of infection after autogenous bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstructions. From January 1991 to November 1996 we experienced only 2 infected knees in 1,300 reconstructions, but between December 1996 and February 1997 10 patients in 70 ACL reconstructions developed a postoperative suspected infection. We found the origin of contamination (coagulase-negative Staphylococcus) in the supposedly sterile inflow cannula. When we changed this device, we had only 1 infection in the next 400 reconstructions. The diagnosis in these cases was derived from clinical signs and laboratory results, but only 2 of 11 samples of aspirated synovial fluid tested positive for Staphylococcus. The mean interval between the surgery and the onset of signs of infection and the start of antibiotic therapy was 7.7 days. All the patients had antibiotic association at the highest level. Six knees underwent arthroscopic debridement when the clinical signs indicated resistence to antibiotics. The normal postoperative rehabilitation program was modified but was not discontinued. Although recovery time was longer, overall results were similar to uncomplicated reconstructions. On the basis of our experience, we believe that when there is a notable increase in infection rates, a thorough search for contamination is indicated. Our source of infection was material that was thought to be sterile. Ultimately, early diagnosis and treatment is of critical importance to obtain good results. Even suspicion of infective postoperative complication should be sufficient cause to search for responsible microorganisms and begin antibiotic therapy. Arthroscopic debridement should be proposed to patients with resistence to antibiotics. PMID:10705329

Viola, R; Marzano, N; Vianello, R

2000-03-01

181

Arthroscopic surgery for treatment of anterior displacement of the disc without reduction of the temporomandibular joint.  

PubMed

The aim of this study was to investigate the clinical results and efficacy of an arthroscopic approach to correct anterior displacement of the disc without reduction of the temporomandibular joint (TMJ) with limitation of mouth opening. We studied 28 joints with internal derangement in 23 patients, all of whom had had arthroscopic surgery (lavage, lysis of adhesions in the superior compartment, incision parallel to the disc-synovial crease of the upper joint compartment, and pull back of the anteriorly located disc). Objective and subjective data (increase in maximal interincisal opening, magnetic resonance imaging, and visual analogue pain score, VAS) were collected preoperatively and at 7, 30, 60 days, and 6 months or more postoperatively. Maximal interincisal opening improved from a mean (SD) of 20.4 (±4.5) mm preoperative measurement to 38.9 (±3.2) mm by 6 months postoperatively where indicated in previous line. The VAS showed a significant improvement in pain score (p=0.0023). Sixty days postoperatively the positions of the discs in 14 of the TMJs had improved considerably. In 13 of the TMJs the positions had improved slightly. Only 1 of the TMJs had not improved at all. There were no complications in any patient. Our arthroscopic procedure is safe, minimally invasive, and effective for the treatment of patients with displacement of the disc anteriorly without reduction of the TMJ. PMID:21377774

Zhu, YaoMin; Zheng, CangShang; Deng, YongQiang; Wang, Yang

2012-03-01

182

Arthroscopic resection of the calcaneonavicular coalition or the "too long" anterior process of the calcaneus.  

PubMed

Calcaneonavicular coalition and the "too long" anterior process (TLAP) of the calcaneus can manifest as lateral foot pain, peroneal spastic flatfoot, and repeated ankle sprain. Surgical resection of the bone bar is frequently required. We present here an arthroscopic approach that can be used to accurately assess pathoanatomy and resect the bone bar. A portal is established slightly dorsal to the angle of Gissane. This is the primary visualization portal. The working portal, which is identified under an image intensifier, is located at the space between the talonavicular and calcaneocuboid joints, directly over the TLAP or the calcaneonavicular coalition. With the 2.7-mm 30 degrees arthroscope placed at the primary visualization portal, soft tissue around the TLAP or the calcaneonavicular coalition is cleared up with the use of an arthroscopic shaver at the working portal. After the TLAP or the calcaneonavicular coalition is clearly visualized, it can be resected with an arthroscopic burr through the working portal. The bone bar is resected proximally until the medial side of the calcaneocuboid joint, the lateral side of the taloavicular joint, and the plantar-lateral aspect of the talar head are clearly seen. Inversion stress should then be applied to the foot to prevent further impingement of the anteromedial process of the calcaneus to the plantar-lateral part of the talar head. PMID:16904593

Lui, Tun Hing

2006-08-01

183

Early outcome of arthroscopic Bankart's repair for recurrent traumatic anterior shoulder instability  

PubMed Central

Background/objectives Despite the improvements in the methods of arthroscopic stabilization of anterior shoulder instability, a recurrence rate of as high as 30% is reported in the literature. In this context, we report the outcome of arthroscopic Bankart repair in anterior shoulder instability, with the use of bio-absorbable suture anchors for patients that were followed up for at least two years from the date of surgery. The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2-year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder. Methods Data from 79 shoulders in 74 patients were collected over 4 years (2005–2009). Each patient was followed up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their anterior shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA) shoulder rating scale and the Simple Shoulder Test (SST) score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated. Results SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p < 0.0001). Data from the UCLA scale showed a pre and post-operative mean of 20.2 ± 5.0 and 32.4 ± 4.6 respectively (p < 0.0001). 34 had excellent post-operative scores, 35 had good scores, 1 had fair score and 3 had poor scores. 75% of the patients returned to sports while 7.6% developed a recurrence of shoulder dislocation or subluxation. Conclusion Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates.

Saccomanni, Bernardino

2013-01-01

184

Isokinetic strength of the quadriceps and hamstrings and functional ability of anterior cruciate deficient knees in recreational athletes.  

PubMed Central

OBJECTIVE: To test the hypothesis that increasing the hamstrings and quadriceps (H:Q) isokinetic strength ratio will, in the short term, improve the functional ability of an anterior cruciate ligament (ACL) deficient knee. METHODS: The isokinetic muscular characteristics at a speed of 60 degrees s-1 and 180 degrees s-1 of 46 recreational athletes with an arthroscopically confirmed ACL tear were determined using the Cybex II+ isokinetic dynamometer. The variables tested included peak torque, endurance ratio, total work output, and explosive power. Functional ability was scored with the Cincinnati rating system, measuring the severity of pain and swelling, the degree of giving way, and the overall ability to walk, run, ascent and descent stairs, jump and twist. RESULTS: Among all muscular characteristics, the H:Q ratio at 180 degrees s-1 at 30 degrees of knee flexion was shown to have the highest correlation to the functional score (r = 0.6249, P < 0.001). All variables involving hamstring strength were shown to be significantly correlated to the functional ability score (P < 0.01), while none of the variables involving quadriceps strength showed significant correlation with the functional ability of the injured knee. CONCLUSIONS: The H:Q ratio is strongly correlated to the functional ability of ACL deficient knees in Chinese recreational athletes. It could be used as an additional measure to guide in the decision making process in the management of ACL deficient knees. PMID:8799604

Li, R C; Maffulli, N; Hsu, Y C; Chan, K M

1996-01-01

185

Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts: sixty cases with 2 years' minimum follow-up.  

PubMed

A prospective study was performed on 101 patients who underwent an arthroscopic anterior cruciate ligament (ACL) reconstruction with fresh-frozen patellar tendon allograft (bone-patellar tendon-bone). We present the results of the first 60 patients with a minimum follow-up of 2 years. Thirty-four were men and 26 women with a mean age of 23. In 45 patients, a postoperative arthroscopy was performed, and tissue biopsies of the reconstructed ACL were obtained. Patients were evaluated according to the International Knee Documentation Committee evaluation form. After a mean follow-up of 47 months, the overall results were normal or nearly normal in 85%. Under postoperative arthroscopy, the macroscopic appearance of the implant was similar to that of a normal ligament. The ACL allograft was covered with a normal, well-vascularized synovium. There were no cases of infection, disease transmission or tissue rejection. We conclude that the use of fresh-frozen patellar tendon allografts is a good method of ACL reconstruction. PMID:8961227

Nín, J R; Leyes, M; Schweitzer, D

1996-01-01

186

Football Cleat Design and Its Effect on Anterior Cruciate Ligament InjuriesA Three-Year Prospective Study  

Microsoft Academic Search

A 3-year prospective study was initiated to evaluate torsional resistance of modern football cleat designs and the incidence of surgically documented anterior cruciate ligament tears in high school football players wearing different cleat types. We compared four styles of football shoes and evaluated the incidence of ante rior cruciate ligament tears among 3119 high school football players during the 1989

Rick B. Lambson; Bill S. Barnhill; Robert W. Higgins

1996-01-01

187

Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique  

PubMed Central

We established a method for creation of an anatomic femoral tunnel with minimal damage to the remnant bundle in remnant-preserving anterior cruciate ligament (ACL) reconstruction. The goals of this surgical technique were to preserve the remnant bundle as much as possible, especially at the femoral insertion, and to make the tunnel at the anatomic position. The critical points are that the posterior side of the femoral footprint of the ACL is observed through the posterolateral portal using a 70° arthroscope and a femoral tunnel is made by use of an outside-in technique with remnant preservation. This technique allows for easy viewing of the posterior side of the ACL and enables performance of an anatomic ACL reconstruction. PMID:24749041

Ahn, Jin Hwan; Lee, Yong Seuk; Lee, Seung Hee

2014-01-01

188

The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient  

Microsoft Academic Search

Tears of the anterior cruciate ligament (ACL) in the skeletally immature patient are becoming more prevalent. The aim of this\\u000a study was to describe the functional outcome and to evaluate the best management of total tears of the ACL in skeletally immature\\u000a patient. Twenty consecutive, skeletally immature patients with a clinically evident rupture of the anterior cruciate ligament\\u000a were followed

Stephanie Arbes; Christoph Resinger; Vilmos Vécsei; Thomas Nau

2007-01-01

189

Longitudinal Assessment of Noncontact Anterior Cruciate Ligament Injury Risk Factors During Maturation in a Female Athlete: A Case Report  

PubMed Central

Objective: To present a unique case of a young pubertal female athlete who was prospectively monitored for previously identified anterior cruciate ligament (ACL) injury risk factors for 3 years before sustaining an ACL injury. Background: In prospective studies, previous investigators have examined cross-sectional measures of anatomic, hormonal, and biomechanical risk factors for ACL injury in young female athletes. In this report, we offer a longitudinal example of measured risk factors as the participant matured. Differential Diagnosis: Partial or complete tear of the ACL. Measurements: The participant was identified from a cohort monitored from 2002 until 2007. No injury prevention training or intervention was included during this time in the study cohort. Findings: The injury occurred in the year after the third assessment during the athlete's club basketball season. Knee examination, magnetic resonance imaging findings, and arthroscopic evaluation confirmed a complete ACL rupture. The athlete was early pubertal in year 1 of the study and pubertal during the next 2 years; menarche occurred at age 12 years. At the time of injury, she was 14.25 years old and postpubertal, with closing femoral and tibial physes. For each of the 3 years before injury, she demonstrated incremental increases in height, body mass index, and anterior knee laxity. She also displayed decreased hip abduction and knee flexor strength, concomitant with increased knee abduction loads, after each year of growth. Conclusions: During puberty, the participant increased body mass and height of the center of mass without matching increases in hip and knee strength. The lack of strength and neuromuscular adaptation to match the increased demands of her pubertal stature may underlie the increased knee abduction loads measured at each annual visit and may have predisposed her to increased risk of ACL injury. PMID:19180226

Myer, Gregory D; Ford, Kevin R; Divine, Jon G; Wall, Eric J; Kahanov, Leamor; Hewett, Timothy E

2009-01-01

190

Anterior cruciate ligament reconstruction creating the femoral tunnel through the anteromedial portal. Surgical technique.  

PubMed

The anterior cruciate ligament reconstruction is a common procedure that improves stability and function of the knee. The surgical technique continues to evolve and many issues are still under debate. These mainly include: (1) graft selection (patellar tendon, hamstring, quadriceps tendon, or allografts), (2) surgical technique (double versus single bundle), and (3) femoral tunnel drilling. Currently, the most controversial one is the femoral tunnel drilling (transtibial vs. anteromedial portal drilling). Common opinion is that drilling the femoral tunnel through the anteromedial (AM) allows a more anatomic placement of the graft and a better rotational stability; therefore, this technique is gaining in popularity compared with the transtibial drilling despite a greater difficulty and the risk of medial condyle damage, tunnel back wall blowout, and inadequate socket length. The aim of this article is to describe the surgical technique of the anterior cruciate ligament reconstruction (single and double bundle), drilling the femoral tunnel through the AM portal. PMID:21541700

Pastrone, Antonio; Ferro, Andrea; Bruzzone, Matteo; Bonasia, Davide E; Pellegrino, Pietro; D'Elicio, Davide; Cottino, Umberto; Rossi, Roberto

2011-06-01

191

Anterior Cruciate Ligament Femoral Socket Drilling With a Retrograde Reamer: Lessons From the Learning Curve  

PubMed Central

Whereas “anatomic” anterior cruciate ligament reconstruction may improve clinical results, the technique has introduced new technical challenges. The purpose of this technical note and video is to explore tips and tricks that improve femoral socket drilling with a retrograde reamer, bone–patellar tendon–bone graft passage, and interference screw fixation. The techniques for retrograde femoral socket drilling in an inside-out direction, bone–patellar tendon–bone graft passage, and interference screw fixation are described and demonstrated. Pitfalls, troubleshooting tips, and possible solutions are discussed. With the retrograde reamer, the femoral socket can be placed in the footprint of the anterior cruciate ligament with a longer and more vertical tunnel. By modifying the size of the patellar bone plug, graft passage is improved. With care and technique, interference screw fixation in the femoral socket over a guidewire is possible. PMID:24400187

Ferraz, Victor; Westerberg, Paul; Brand, Jefferson C.

2013-01-01

192

Early Clinical Results of Arthroscopic Remplissage in Patients with Anterior Shoulder Instability with Engaging Hill-Sachs Lesion in Iran  

PubMed Central

Background: To assess the outcome of the remplissage arthroscopic surgical method in patients with anterior shoulder dislocation associated with Hill-Sachs lesion. Methods: Ten patients with anterior shoulder dislocations and Hill-Sachs lesions were entered into this study and were operated on by the remplissage arthroscopic surgical method. They were followed up 22 months after surgery in order to evaluate the outcome of the treatment, including recurrence of dislocation and motion limitation. Results: During the internal follow up period, no case of recurrence was found. Motion limitation during the follow up period was not significant (internal rotation limitation=5°±1°, and external rotation limitation=4°±1°) Conclusions: Our findings suggest that the remplissage arthroscopic surgical method is an acceptable, safe and reliable treatment for anterior shoulder dislocation with engaging Hill-Sachs lesion. PMID:25207312

Aslani, Hamidreza; Zafarani, Zohreh; Ebrahimpour, Adel; Salehi, Shahin; Moradi, Ali; Sabzevari, Soheil

2014-01-01

193

Relationship of the menstrual cycle phase to anterior cruciate ligament injuries in teenaged female athletes  

Microsoft Academic Search

Introduction  Anterior cruciate ligament (ACL) injuries are more common among female athletes compared to male athletes. Several studies\\u000a have been reported to explain the gender difference in ACL injury rates and several risk factors underlying gender disparity\\u000a are believed to exist. Hormonal effects are considered to be one of the etiological factors for female non-contact ACL injuries.\\u000a The objectives of this

Noriko Adachi; Koji Nawata; Michio Maeta; Youichi Kurozawa

2008-01-01

194

Anterior cruciate ligament reconstruction using cryopreserved irradiated bone-ACL-bone-allograft transplants  

Microsoft Academic Search

Bone-ACL-bone allograft transplantation has been investigated as a potential solution to reconstruction of the anterior cruciate ligament (ACL). To minimize disease transmission (e.g. the acquired immuno deficiency syndrome), bony and collagenous tissues should be sterilized. Recent animal studies indicate that gamma irradiation and ethylene oxide sterilization result in diminished histological and biomechanical properties. The purpose of the present study was

M. J. Goertzen; H. Clahsen; K. F. Biirrig; K.-P. Schulitz

1994-01-01

195

Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis  

Microsoft Academic Search

There is no consensus in the literature regarding the optimal timing of surgical reconstruction of the ruptured anterior cruciate\\u000a ligament (ACL). Previous authors have suggested that early reconstruction may facilitate an early return to work or sport\\u000a but may increase the incidence of post-operative complications such as arthrofibrosis. This study systematically reviewed\\u000a the literature to determine whether ACL reconstruction should

Toby O. Smith; Leigh Davies; Caroline B. Hing

2010-01-01

196

Contributions of Femoral Fixation Methods to the Stiffness of Anterior Cruciate Ligament Replacements at Implantation  

Microsoft Academic Search

Summary: One purpose of this study was to determine the stiffness of three femoral fixation methods used commonly in anterior cruciate ligament (ACL) reconstruction to secure a double-looped semitendinosus and gracilis (DLSTG) graft and then assess how the stiffness of these methods affects the stiffness of the young human femur-fixation method-graft complex at the time of reconstruction. A second purpose

John T. To; Lt Col Stephen M. Howell; Maury L. Hull

1999-01-01

197

[MRT of the status following augmentation plasty of the anterior cruciate ligament using carbon fibers].  

PubMed

In 19 patients treated with carbon-fiber ligament augmentation for the anterior cruciate ligament, the clinical findings were compared via MRI. Visualization of the intra- and extra-articular portion of the graft was possible in 84%. The integrity of the ligaments was be shown in an equal percentage. Thus, MRI is a useful diagnostic tool for non-invasive imaging for repeated follow-ups in patients with carbon-fiber ligament augmentation. PMID:2587734

Fezoulidis, I; Neuhold, A; Wicke, L; Sim, T; Dimopoulos, I

1989-11-01

198

Strain rate effect on the mechanical behavior of the anterior cruciate ligament–bone complex  

Microsoft Academic Search

Traction tests were performed on the bovine anterior cruciate ligament–bone complex at seven strain rates (0.1, 1, 5, 10, 20, 30, 40%\\/s). Corresponding stress–strain curves showed that, for a given strain level, the stress increased with the augmentation of the strain rate. This phenomenon was important since the stress increased by a factor of three between the tests performed at

D. P. Pioletti; L. R. Rakotomanana; P.-F. Leyvraz

1999-01-01

199

Acute Simultaneous Ruptures of the Anterior Cruciate Ligament and Patellar Tendon  

PubMed Central

Acute simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare injury. We present a case report of a 32-year-old male patient with ruptured ACL and ipsilateral patellar tendon rupture sustained while playing baseball. Surgery was performed on the patellar tendon and the ACL simultaneously. The clinical and radiological outcomes of the treatment were successful. We present this case with a review of the literatures. PMID:24639949

Lee, Gwang Chul; Park, Sung-Hae

2014-01-01

200

Biodegradable screw presents as a loose intra-articular body after anterior cruciate ligament reconstruction  

Microsoft Academic Search

We report a case of intra-articular movement of a broken piece of a poly-L-lactide (PLLA) bioabsorbable interference screw from the femoral tunnel in anterior cruciate ligament (ACL) reconstruction with quadrupled semi-tendinosus and gracilis tendon grafts. Eleven months after initially successful ACL surgery, the patient felt a sudden locking of the knee without associated trauma or injury. The patient experienced pain

Peter MacDonald; Shalinder Arneja

2003-01-01

201

Substance P immunoreactive fibers of synovial tissue in patients with anterior cruciate ligament injury  

Microsoft Academic Search

Substance P, a neuropeptide, exerts proinflammatory effects and transmits the sensation of pain. Substance P immunoreactive\\u000a fibers of the synovial tissue were examined to investigate the significance of Substance P in the traumatic joint. Biopsy\\u000a specimens from 15 patients (eight female and seven male) with anterior cruciate ligament (ACL) injury were examined immunohistochemically\\u000a with semi-quantitative counting to correlate Substance P

Bo Zhang; Takeshi Muneta; Kazuyoshi Yagishita; Ichiro Sekiya

2006-01-01

202

Anterior cruciate ligament repair with LARS (ligament advanced reinforcement system): a systematic review  

Microsoft Academic Search

Background  Injury to the anterior cruciate ligament (ACL) of the knee is common. Following complete rupture of the ACL, insufficient\\u000a re-vascularization of the ligament prevents it from healing completely, creating a need for reconstruction. A variety of grafts\\u000a are available for use in ACL reconstruction surgery, including synthetic grafts. Over the last two decades new types of synthetic\\u000a ligaments have been

Zuzana Machotka; Ian Scarborough; Will Duncan; Saravana Kumar; Luke Perraton

2010-01-01

203

Septic arthritis following anterior cruciate ligament reconstruction using tendon allografts--Florida and Louisiana, 2000.  

PubMed

In the United States, approximately 50,000 knee surgeries are performed each year for repairing anterior cruciate ligament (ACL) injuries. Tissue allografts frequently are used for ACL reconstruction, and septic arthritis is a rare complication of such procedures. This report describes four patients who acquired postsurgical septic arthritis probably associated with contaminated bone-tendon-bone allografts used for ACL reconstruction. Effective sterilization methods that do not functionally alter musculoskeletal tissue are needed to prevent allograft-related infections. PMID:11770503

2001-12-01

204

Inferior Lateral Genicular Artery Injury during Anterior Cruciate Ligament Reconstruction Surgery  

PubMed Central

We report a case of inferior lateral genicular artery (ILG) injury during anterior cruciate ligament (ACL) reconstruction surgery with lateral partial meniscectomy. This is a rare arthroscopy complication. A review of the literature has been made with the aim to define the anatomy of ILG across the lateral articular line and the risk of lesion during knee arthroscopy. We propose embolization as a good treatment option for this type of injuries. PMID:22957293

Lamo-Espinosa, J. M.; Llombart Blanco, R.; Valentí, J. R.

2012-01-01

205

Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction.  

PubMed

Anterior cruciate ligament (ACL) injuries are the most common complete ligamentous injury to the knee. The optimal graft should be able to reproduce the anatomy and biomechanics of the ACL, be incorporated rapidly with strong initial fixation, and cause low graft-site morbidity. This article reviews the literature comparing the clinical outcomes following allograft and autograft ACL reconstruction and examines current issues regarding graft choice. PMID:17920959

Baer, Geoffrey S; Harner, Christopher D

2007-10-01

206

Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines  

Microsoft Academic Search

Purpose  Anterior cruciate ligament (ACL) mucoid degeneration is a rare encounter in clinical practice, different, but often confused\\u000a with ACL mucoid cysts. Its pathophysiology remains unclear. However, recent publications have suggested that it might be underdiagnosed\\u000a or misdiagnosed, and that the adverse effects of treatment by ACL resection might be underestimated. The object of this work\\u000a was to summarize this scattered

Francois Lintz; Nicolas Pujol; Philippe Boisrenoult; Kevin Bargoin; Philippe Beaufils; David Dejour

2011-01-01

207

Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature  

Microsoft Academic Search

Anterior cruciate ligament (ACL) rupture, one of the most common knee injuries in sports, results in anteroposterior laxity,\\u000a which often leads to an unstable knee. Traditional ACL reconstruction is performed with autograft; disadvantages of this technique\\u000a are donor site morbidity and a long rehabilitation period. In the 1980s, artificial ligaments became an attractive alternative\\u000a to biological grafts. The initial enthusiasm

Claudio Legnani; Alberto Ventura; Clara Terzaghi; Enrico Borgo; Walter Albisetti

2010-01-01

208

Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female AthletesA Prospective Study  

Microsoft Academic Search

Background: Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes.Hypothesis: Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading, predicting anterior cruciate ligament injury risk.Study Design: Cohort study; Level of evidence, 2.Methods: There were 205 female athletes

Timothy E. Hewett; Gregory D. Myer; Kevin R. Ford; Robert S. Heidt; Angelo J. Colosimo; Scott G. McLean; Antonie J. van den Bogert; Mark V. Paterno; Paul Succop

2005-01-01

209

Mechanisms for Noncontact Anterior Cruciate Ligament InjuriesKnee Joint Kinematics in 10 Injury Situations From Female Team Handball and Basketball  

Microsoft Academic Search

Background: The mechanism for noncontact anterior cruciate ligament injury is still a matter of controversy. Video analysis of injury tapes is the only method available to extract biomechanical information from actual anterior cruciate ligament injury cases.Purpose: This article describes 3-dimensional knee joint kinematics in anterior cruciate ligament injury situations using a model-based image-matching technique.Study Design: Case series; Level of evidence,

Hideyuki Koga; Atsuo Nakamae; Yosuke Shima; Junji Iwasa; Grethe Myklebust; Lars Engebretsen; Roald Bahr; Tron Krosshaug

2010-01-01

210

Analysis of the functional results of arthroscopic Bankart repair in posttraumatic recurrent anterior dislocations of shoulder  

PubMed Central

Background: The Bankart lesion represents the most common form of labro-ligamentous injury in patients with traumatic dislocations of the shoulder leading to shoulder instability. We report the clinical outcome of arthroscopic repair of Bankart lesion in 50 patients. Materials and Methods: Sixty five patients with posttraumatic anterior dislocation of shoulder were treated by arthroscopic repair from Jan 2005 to Nov 2008. Fifty patients, with an average age of 26.83 years (range 18-45 years), were reviewed in the study. The average followup period was 27 months (range 24-36 months). University of California Los Angeles shoulder rating scale was used to determine the outcome after surgery. The recurrence rates, range of motion, as well as postoperative function and return to sporting activities were evaluated. Results: Thirty six patients (72.0%) had excellent results, whereas seven patients (14.0%) had good results. The mean pre- and postoperative range of external rotation was 80.38° and 75.18°, respectively. Eighty-six percent patients had stability compared with the normal sided shoulder and were able to return to sports. There were no cases of redislocation observed in this study; however, three cases had mild laxity of the joint. Conclusion: Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent postoperative shoulder motion and low recurrence rates. PMID:23325970

Mishra, Amit; Sharma, Pulak; Chaudhary, Deepak

2012-01-01

211

Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion–Based Rehabilitation Progression  

PubMed Central

SYNOPSIS The management of patients after anterior cruciate ligament reconstruction should be evidence based. Since our original published guidelines in 1996, successful outcomes have been consistently achieved with the rehabilitation principles of early weight bearing, using a combination of weight-bearing and non–weight-bearing exercise focused on quadriceps and lower extremity strength, and meeting specific objective requirements for return to activity. As rehabilitative evidence and surgical technology and procedures have progressed, the original guidelines should be revisited to ensure that the most up-to-date evidence is guiding rehabilitative care. Emerging evidence on rehabilitative interventions and advancements in concomitant surgeries, including those addressing chondral and meniscal injuries, continues to grow and greatly affect the rehabilitative care of patients with anterior cruciate ligament reconstruction. The aim of this article is to update previously published rehabilitation guidelines, using the most recent research to reflect the most current evidence for management of patients after anterior cruciate ligament reconstruction. The focus will be on current concepts in rehabilitation interventions and modifications needed for concomitant surgery and pathology. PMID:22402434

ADAMS, DOUGLAS; LOGERSTEDT, DAVID; HUNTER-GIORDANO, AIRELLE; AXE, MICHAEL J.; SNYDER-MACKLER, LYNN

2013-01-01

212

Isometric versus tension measurements. A comparison for the reconstruction of the anterior cruciate ligament.  

PubMed

This study was designed to compare the displacement patterns of an isometer, used to determine graft placement during reconstruction, with the actual tensions on an anterior cruciate ligament substitute. In cadaveric specimens, a Kevlar anterior cruciate ligament substitute was implanted in three separate femoral sites, each of which was subsequently fixed to two different tibial sites. The initial tension of the Kevlar substitute was set to 22 or 33 N at 20 degrees of knee flexion. The displacement patterns for each position were recorded during passive flexion-extension using the isometer. Using a custom-designed tensiometer, the tensile forces on the substitute after rigid fixation at the tibia and femur were measured. During passive flexion-extension, the maximum change in tension of the anterior cruciate ligament substitute, measured by the tensiometer, was correlated with the maximum change in displacement between attachment sites, measured by the isometer. The coefficient of determination was equal to 0.15, indicating that the isometer may not accurately predict the tensions developed in the substitute. PMID:8427374

Fleming, B; Beynnon, B D; Johnson, R J; McLeod, W D; Pope, M H

1993-01-01

213

In-vitro correlation between tension and length change in an anterior cruciate ligament substitute.  

PubMed

The length change and tension patterns from multiple insertion locations of an anterior cruciate ligament substitute were studied in 10 cadaver knees. Length change was measured with a spring-loaded isometer of low stiffness, and tension was measured with a piezoelectric load cell. In both instances a thin Kevlar test ligament was positioned in five different femoral and two different tibial ligament insertion locations, that were all located within the normal attachments of the anterior cruciate ligament. Differences were found regarding length changes and tension patterns from a simulated active extension between the central, posterior, and anterior femoral locations. All locations showed larger length change and tension values in extension than in flexion. The anterior femoral ligament insertion location showed length change and tension patterns with increasing values in flexion compared to the other femoral locations. The anterior tibial ligament insertion location showed smaller excursions of both length and tension, than did the central one, but the patterns of the curves were similar. A statistically significant correlation was found between length change and tension patterns throughout a 130-0 degrees range of motion. A statistically significant correlation was also found between the maximum length and tension values. No fixed relationship was found between the magnitude of the length and tension values, when different intervals of the range of motion were studied. RELEVANCE: The intraoperative employment of length change measurements of a test ligament in anterior cruciate ligament reconstruction gives information on where high tension can be expected in the range of motion of the knee, and how this can differ depending on the angle of graft fixation. The information gained can also be used to improve drill channel location. However, no predictions on the magnitude of tension can be made, mainly due to large biological variability. PMID:11415553

Good, L

1995-06-01

214

Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability.  

PubMed

Background? Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives? Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy? A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria? Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2?years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40?years or older, or had multidirectional instability or other concomitant shoulder pathology were excluded. Data collection and analysis? Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. Results? Eleven studies were included in the review. Two were randomised controlled trials. Evidence comparing arthroscopic and open surgical glenohumeral stabilisation was of poor to fair methodological quality. Hence, the results of primary studies should be interpreted with caution. Observed clinical heterogeneity in populations and outcomes was highlighted and should be considered when interpreting the meta-analysis. Authors also used variable definitions of recurrent instability and a variety of outcome measures, which made it difficult to synthesise results. When comparable data were pooled, there were no significant differences (P?>?0.05) between the arthroscopic and open groups with respect to recurrent instability rates, Rowe score, glenohumeral external rotation range and complication rates. Conclusions? Statistically, it appears that both surgical techniques are equally effective in managing traumatic anterior glenohumeral instability. In light of the methodological quality of the included studies, it is not possible to validate arthoscopic stabilisation to match open surgical stabilisation as the gold standard treatment. Further research using multicentred randomised controlled trials with sufficient power and instability-specific questionnaires with sound psychometric properties is recommended to build on current evidence. The choice of treatment should be based on multiple factors between the clinician and the patient. PMID:21631787

Ng, Choong; Bialocerkowski, Andrea; Hinman, Rana

2007-06-01

215

The effect of neuromuscular electrical stimulation during closed kinetic chain exercise on lower extremity performance following anterior cruciate ligament reconstruction  

Microsoft Academic Search

No studies have examined the effect of augmenting closed kinetic chain (CKCh) exercises with neuromuscular electrical stimulation (NMES) following anterior cruciate ligament (ACL) reconstruction. Therefore, the purpose of this study was to compare the effect of supplementing a CKCh training program with NMES during the initial six weeks following ACL reconstruction on anterior tibiofemoral joint laxity and the following CKCh

Michael Ross

2000-01-01

216

Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament  

Microsoft Academic Search

Reconstruction of a torn anterior cruciate ligament (ACL) cannot be successful without a properly placed tibial tunnel. Preventable complications such as anterior knee pain, effusions, extension loss, and recurrent instability can occur when the tibial tunnel is improperly placed and the roof and notchplasty are insufficient. This article reviews the principles for anatomic placement of the tibial tunnel so that

Stephen M. Howell

1998-01-01

217

The Effects of Generalized Joint Laxity on Risk of Anterior Cruciate Ligament Injury in Young Female Athletes  

PubMed Central

Background Women who participate in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than men. Purpose To prospectively determine if female athletes with decreased passive knee joint restraint (greater joint laxity) and greater side-to-side differences in knee laxity would be at increased risk of anterior cruciate ligament injury. Study Design Case control study; Level of evidence, 3. Methods From 1558 female soccer and basketball players who were prospectively screened, 19 went on to tear their anterior cruciate ligaments. Four height- and mass-matched control subjects were selected from the uninjured screened athletes for comparison with each of the 19 injured subjects, making a total of 95 subjects (19 injured; 76 uninjured). Generalized joint-laxity tests and anterior-posterior tibiofemoral translation were quantified using the CompuKT knee arthrometer. A multivariable logistic regression model was constructed to determine predictors of anterior cruciate ligament injury status from recorded laxity measures. Results A multivariable logistic regression model (chi-square = 18.6; P = .002) used the independent variables laxity measures of knee hyperextension (P = .02), wrist and thumb to forearm opposition (P = .80), fifth-finger hyperextension >90° (P = .71), side-to-side differences in anterior-posterior tibiofemoral translation (P = .002), and prior knee injury (P = .22) to predict anterior cruciate ligament–injury status. The validated C statistic, or validated area under the receiver operating characteristic curve, was 0.72. For every 1.3-mm increase in side-to-side differences in anterior-posterior knee displacement, the odds of anterior cruciate ligament–injured status increased 4-fold (95% confidence interval, 1.68–9.69). A positive measure of knee hyperextension increased the odds of anterior cruciate ligament–injured status 5-fold (95% confidence interval, 1.24–18.44). Conclusion The current results indicate that increased knee-laxity measures may contribute to increased risk of anterior cruciate ligament injury. The methods to quantify knee joint laxity in this report may be used in conjunction with measures of neuromuscular control of the knee joint to identify high-risk female athletes with high accuracy. Once high-risk female athletes are identified, they may be targeted to the appropriate interventions to reduce injury risk. PMID:18326833

Myer, Gregory D.; Ford, Kevin R.; Paterno, Mark V.; Nick, Todd G.; Hewett, Timothy E.

2012-01-01

218

The O'Donoghue triad revisited. Combined knee injuries involving anterior cruciate and medial collateral ligament tears.  

PubMed

We identified 60 consecutive patients with combined anterior cruciate and medial collateral ligament (ACL-MCL) disruptions that were incurred during athletic endeavors. Each underwent acute reconstruction of the ACL. The arthroscopic data obtained at the time of reconstructive surgery was reviewed in order to determine the incidence of O'Donoghue's triad (the "unhappy triad"), consisting of ACL, MCL, and medial meniscus tears. Patients were subdivided into two groups for analysis based upon the degree of MCL injury at time of presentation (Group I, 35 patients with a second-degree sprain; Group II, 25 patients with a complete, or third-degree injury). Medial meniscus tears were an uncommon finding. Lateral meniscus tears significantly out-numbered medial meniscus tears in both groups, occurring in 25 (71%) of Group I patients and 8 (32%) of those in Group II. Even chondral fractures of the lateral femoral condyle outnumbered medial meniscus tears [6 (17%) versus 4 (11%)] in patients with a second-degree MCL sprain. Furthermore, when present in Group I patients, tears of the medial meniscus were associated with a concomitant lateral meniscus injury. Group II patients were more likely (60%) than Group I not to have any meniscal abnormality at all. We conclude that the classic O'Donoghue triad is, in fact, an unusual clinical entity among athletes with knee injuries; it might be more accurately described as a triad consisting of ACL, MCL, and lateral meniscus tears. This injury combination appears to be more common when an incomplete, or second-degree, tear of the medial collateral has occurred.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1962712

Shelbourne, K D; Nitz, P A

1991-01-01

219

Estrogen Affects the Cellular Metabolism of the Anterior Cruciate LigamentA Potential Explanation for Female Athletic Injury  

Microsoft Academic Search

Investigations from this laboratory have established the presence of estrogen receptors in the human an terior cruciate ligament. This study further investigates the effects of 17?-estradiol on the cellular proliferation and collagen synthesis of fibroblasts derived from the rabbit anterior cruciate ligament. Fibroblast prolifera tion and collagen synthesis in response to near log concentrations of 17?-estradiol (at 0.0029, 0.025, 0.25,

Stephen H. Liu; Raad A. Al-Shaikh; Vahé Panossian; Gerald A. M. Finerman

1997-01-01

220

Arthroscopic Latarjet and Capsular Shift (ALCS) Procedure: A New "Freehand" Technique for Anterior Shoulder Instability Associated With Significant Bone Defects.  

PubMed

Anterior shoulder instability associated with significant bone loss has been described as "bony-instability," and this condition is usually treated with an anterior glenoid bone grafting procedure (Latarjet procedure). The Latarjet procedure involves transfer of the horizontal limb of the coracoid process along with the conjoint tendon to the anterior glenoid rim, and is traditionally performed as an open surgical procedure. Recently, an arthroscopic technique for the Latarjet procedure has been described; the technique necessitates the use of specialized instrumentation and involves excision of the entire anterior capsule to facilitate coracoid fixation. We describe a new "freehand" arthroscopic technique for the Latarjet procedure, and, in addition, a simultaneous capsular shift to further optimize mid and end range stability. This technique eliminates the use of additional instrumentation and can be done using routine arthroscopic instruments. Preliminary experience with this technique suggests that the arthroscopic Latarjet and capsular shift is a technically demanding procedure. Glenohumeral capsule can be preserved, and this should be attempted wherever possible to optimize stability. Additional specialized instrumentation would probably reduce surgical time; however, the procedure can be performed with routine instruments. PMID:25393057

Bhatia, Deepak N

2015-03-01

221

Osteogenic potential of cells in vitro derived from haemarthrosis of the knee induced by injury to the anterior cruciate ligament.  

PubMed

We have investigated whether cells derived from haemarthrosis caused by injury to the anterior cruciate ligament could differentiate into the osteoblast lineage in vitro. Haemarthroses associated with anterior cruciate ligament injuries were aspirated and cultured. After treatment with beta-glycerophosphate, ascorbic acid and dexamethasone or 1,25 (OH)(2)D(3), a significant increase in the activity of alkaline phosphatase was observed. Matrix mineralisation was demonstrated after 28 days and mRNA levels in osteoblast-related genes were enhanced. Our results suggest that the haemarthrosis induced by injury to the anterior cruciate ligament contains osteoprogenitor cells and is a potential alternative source for cell-based treatment in such injury. PMID:16365136

Lee, S Y; Miwa, M; Sakai, Y; Kuroda, R; Niikura, T; Kurosaka, M

2006-01-01

222

Can platelet-rich plasma enhance anterior cruciate ligament and meniscal repair?  

PubMed

The use of platelet-rich plasma (PRP) to improve clinical outcome following a soft tissue injury, regeneration, and repair has been the subject of intense investigation and discussion. This article endeavors to relate clinical and basic science strategies focused on biological augmentation of the healing response in anterior cruciate ligament (ACL) and meniscus repair and replacement using PRP. Therein, a translational feedback loop is created in the literature and targeted towards the entire multidisciplinary team. Ultimately, it is hoped that the theoretical benefits of PRP on soft-tissue interfacial healing will emerge clinically following a careful, focused characterization at the benchtop, and prospective randomized controlled clinical study. PMID:25101873

Hutchinson, Ian D; Rodeo, Scott A; Perrone, Gabriel S; Murray, Martha M

2015-02-01

223

Anterior cruciate ligament reconstruction improves the metabolic energy cost of level walking at customary speeds  

Microsoft Academic Search

Purpose  The metabolic energy cost of walking is altered by pathological changes in gait. It is thought that anterior cruciate ligament\\u000a (ACL) deficiency alters the energy requirement for level walking through its effect on gait pattern. In this study, it is\\u000a hypothesised that the metabolic energy cost of walking would improve after ACL reconstruction.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Eight patients who were undergoing ACL reconstruction

Mehmet Colak; Irfan Ayan; Ugur Dal; Turan Yaroglu; Figen Dag; Cengiz Yilmaz; Huseyin Beydagi

2011-01-01

224

The "N + 7 rule" for tibial tunnel placement in endoscopic anterior cruciate ligament reconstruction.  

PubMed

Tibial tunnel placement during endoscopic anterior cruciate ligament (ACL) reconstruction has received increased emphasis in the recent literature. Appropriate tunnel length is a critical technical consideration. A tunnel that is too short results in graft extrusion, necessitating supplemental fixation techniques. A tunnel that is too long may make distal fixation and femoral tunnel placement difficult. A simple rule is proposed that allows for correct tunnel length and allows placement of the bone plug consistently within the tibial tunnel, allowing interference screw fixation. PMID:8838744

Miller, M D; Hinkin, D T

1996-02-01

225

Evaluation of meniscal mechanics and proteoglycan content in a modified anterior cruciate ligament transection model.  

PubMed

Post-traumatic osteoarthritis (PTOA) develops as a result of traumatic loading that causes tears of the soft tissues in the knee. A modified transection model, where the anterior cruciate ligament (ACL) and both menisci were transected, was used on skeletally mature Flemish Giant rabbits. Gross morphological assessments, elastic moduli, and glycosaminoglycan (GAG) coverage of the menisci were determined to quantify the amount of tissue damage 12 weeks post injury. This study is one of the first to monitor meniscal changes after inducing combined meniscal and ACL transections. A decrease in elastic moduli as well as a decrease in GAG coverage was seen. PMID:24749144

Fischenich, Kristine M; Coatney, Garrett A; Haverkamp, John H; Button, Keith D; DeCamp, Charlie; Haut, Roger C; Haut Donahue, Tammy L

2014-07-01

226

Popliteal artery pseudoaneurysm after anterior cruciate ligament re-revision using a rigidfix cross pin.  

PubMed

Popliteal artery injury is a very rare complication of anterior cruciate ligament (ACL) reconstruction. The authors experienced a case of popliteal arterial pseudoaneurysm after re-revision of ACL reconstruction using Rigidfix for femoral tunnel fixation. Pseudoaneurysm was detected in knee magnetic resonance imaging, which caused pain, limit of motion, common peroneal nerve palsy, leg swelling and symptoms similar to compartment syndrome. After excision and re-anastomosis of the popliteal artery using a greater saphenous vein graft, all symptoms were resolved within 3 months except for common peroneal nerve palsy. So we report on this case with a review of the literature. PMID:24944979

Lee, Gwang Chul; Kim, Dong Hwi; Park, Sung-Hae

2014-06-01

227

Tiludronate treatment improves structural changes and symptoms of osteoarthritis in the canine anterior cruciate ligament model  

Microsoft Academic Search

Introduction  The aim of this prospective, randomized, controlled, double-blind study was to evaluate the effects of tiludronate (TLN),\\u000a a bisphosphonate, on structural, biochemical and molecular changes and function in an experimental dog model of osteoarthritis\\u000a (OA).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Baseline values were established the week preceding surgical transection of the right cranial\\/anterior cruciate ligament,\\u000a with eight dogs serving as OA placebo controls and eight

Maxim Moreau; Pascale Rialland; Jean-Pierre Pelletier; Johanne Martel-Pelletier; Daniel Lajeunesse; Christielle Boileau; Judith Caron; Diane Frank; Bertrand Lussier; Jerome RE del Castillo; Guy Beauchamp; Dominique Gauvin; Thierry Bertaim; Dominique Thibaud; Eric Troncy

2011-01-01

228

“Retrograde Technique” for Drilling the Femoral Tunnel in an Anterior Cruciate Ligament Reconstruction  

PubMed Central

Recent literature has led some surgeons to drill the femoral tunnel in an anterior cruciate ligament reconstruction through an accessory anteromedial portal. Several techniques have been reported for the safe, effective drilling of the femoral tunnel by this approach. This technical note presents a new “retrograde technique” in which all instruments are passed independently into the notch and across the medial compartment. This technique is safe and reproducible and allows for meticulous evaluation and creation of the femoral tunnel(s) while minimizing steps. PMID:24400188

Branam, Barton R.; Hasselfeld, Kimberly A.

2013-01-01

229

Instrumented measurement of in vivo anterior-posterior translation in the canine knee to assess anterior cruciate integrity  

PubMed Central

This study was designed to objectively quantify in vivo anterior-posterior canine knee translation relative to anterior cruciate ligament (ACL) integrity. Tibial translation was determined in one knee of 43 crossbreed hounds from radiographs performed while a set anterior and then posterior force was applied to the tibia using a custom designed device. The total (TTT), anterior (ATT), and posterior (PTT) tibial translation were measured (absolute) and normalized to the width of the tibia (normalized). Absolute and normalized TTT was significantly greater in ruptured ACL knees than in partially disrupted (PD) ACL knees, which were significantly greater than in intact ACL knees. ATT and PTT was significantly greater in ruptured ACL knees than in PD or intact ACL knees, which were not significantly different. The sensitivity and specificity of normalized TTT to distinguish knees with intact from PD ACLs were both 100%. Normalized TTT to distinguish knees with PD from ruptured ACLs had a sensitivity and specificity of 100% and 92%, respectively. Intra- and inter-observer intra-class correlation coefficients were 0.84 or higher for all translations. This precise non-invasive technique to assess canine knee translational stability and ACL integrity permits repetitive, objective measurements for diagnostic use and to assess therapeutic intervention efficacy. PMID:15304264

Lopez, Mandi J.; Hagquist, William; Jeffrey, Susan L.; Gilbertson, Sara; Markel, Mark D.

2007-01-01

230

The role of the RNFA in anterior cruciate ligament graft preparation.  

PubMed

Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed orthopedic procedures in the United States. Repair of the ACL often requires the use of autografts or allografts, and the RN first assistant (RNFA) often is the team member responsible for preparing the graft. Common grafts used in ACL repair include bone-patellar tendon-bone, hamstring, Achilles tendon, quadriceps tendon, and tibialis anterior tendon. The RNFA must be competent in preparing all of these grafts and in understanding the advantages and disadvantages of using each graft, such as the reasons for graft choice, and must ensure that all graft-related supplies and equipment are available and ready for use. The ability to prepare all graft types expands treatment options, reduces surgical time, and enhances the role of the RNFA. PMID:25443120

Rozakis, Melissa

2014-11-01

231

Calcium pyrophosphate dihydrate crystal deposition disease after anterior cruciate ligament reconstruction.  

PubMed

We report the case of a 34-year-old woman who presented with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease shortly after anterior cruciate ligament (ACL) reconstruction using a polyester artificial ligament (Leeds-Keio; Neoligaments, Leeds, England). The patient had earlier undergone a medial collateral ligament repair of a sprain to her right knee incurred while skiing. Nine years later, she underwent ACL reconstruction. Seventeen months after ACL reconstruction, calcification was observed on radiographs of the medial and lateral menisci. Based on these calcifications and polarized light microscopic findings of the joint fluid, the diagnosis was made of CPPD crystal deposition. CPPD deposition appeared to have resulted from intra-articular damage incurred during ACL reconstruction as well as prolonged anterior instability. PMID:9754486

Minezaki, T; Tomatsu, T; Hanada, K

1998-09-01

232

One-stage anatomic double bundle anterior and posterior cruciate ligament reconstruction  

PubMed Central

Introduction: Main evidence of the heavy knee dislocations is the rupture of both Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL). There are limited sources for the treatment of both ligaments at a single stage. Materials-method: One-staged anatomic double-bundle ACL and PCL reconstruction technique has been applied to 2 cases aged 20 and 36 with traumatic knee dislocation. Lateral collateral ligament and posteriolateral corner reconstruction added to one case, and medial collateral ligament and posteriomedial corner reconstruction for the other case. Because of additional femur fractures of the both cases, ligament reconstructions have been applied after the main treatment. Anterior tibialis tendon (ATT) allograft has been used for graft for both cases because of other stabilization deficiencies of knees. It has been confirmed that femoral and tibial tunnels constructed with anatomic double-bundle technique are fitting to anatomic locations by the post-operation CT results. Post fixation screw has been used for tibia, and endobutton at femur. Results: Tracking records of patients at 8th month shows that; Lysholm score of the case aged 20 was 89, and 85 for the case aged 36. While KT-1000 values was 3.7 mm, and 4.1 mm for 15 N power; and 9.1 mm-9.6 mm with the maximum power. Conclusion: Surgical technical details of one-staged double-bundle reconstruction for ACL and PCL injuries which is gaining popularity recently has been stated. PMID:25419422

Acar, Baver; Ba?ar?r, Kerem; Armangil, Mehmet; Binnet, Mehmet Serdar

2014-01-01

233

Complete anterior knee dislocation 16 years after cruciate-retaining total knee arthroplasty.  

PubMed

Anterior dislocation after total knee arthroplasty (TKA) is rare; 9 cases have been reported in the English literature. Five patients sustained subluxation, with recurvatum as the clinical manifestation, and 4 patients sustained complete dislocation, usually accompanying other serious complications.This article describes a case of complete dislocation that developed atraumatically 16 years after TKA and was characterized by dislocation in extension and spontaneous reduction in flexion. Revision TKA was planned, with several alternative procedures under consideration, ranging in degree of invasiveness from simple polyethylene exchange to conversion to a hinge-typed prosthesis. Intraoperatively, extensive areas of blackened synovium and posterior-dominant polyethylene wear existed medially and laterally. Considering the patient's age of 82 years, low activity level in activities of daily living, edematous skin, and number of stable components, we performed simple polyethylene exchange to a cruciate-retaining component that left the partial metal defect in the tibial plate untouched. Successful outcome was achieved for >2 years. The dislocation mechanism was polyethylene thinning, leading to relative valgus and anteroposterior instability that aggravated the anterior cruciate ligament dysfunction, which is speculated as the inherent key causative factor in every TKA.Complete dislocation, usually accompanying other complications, requires prompt treatment because the possibility of serious consequences exists. Due to the absence of a gold standard, the treatment of choice needs to be made on a case-by-case basis. PMID:22495865

Sato, Yusuke; Saito, Masahiko; Akagi, Ryuichiro; Suzuki, Masahiko; Kobayashi, Tatsuya; Sasho, Takahisa

2012-04-01

234

The Effect of Skeletal Maturity on Functional Healing of the Anterior Cruciate Ligament  

PubMed Central

Background: The effects of skeletal maturity on functional ligament healing are unknown. Prior studies have suggested that ligament injuries in skeletally mature animals heal with improved mechanical properties. In this study, we hypothesized that skeletally immature animals have improved functional healing compared with skeletally mature animals. Methods: Twenty-one Yucatan minipigs (eight juvenile, eight adolescent, and five adult animals) underwent bilateral anterior cruciate ligament transection. On one side, the ligament injury was left untreated to determine the intrinsic healing response as a function of age. On the contralateral side, an enhanced suture repair incorporating a collagen-platelet composite was performed. Biomechanical properties of the repairs were measured after fifteen weeks of healing, and histologic analysis was performed. Results: Anterior cruciate ligaments from skeletally immature animals had significantly improved structural properties over those of adult animals at three months after transection in both the untreated and repair groups. Use of the enhanced suture technique provided the most improvement in the adolescent group, in which an increase of 85% in maximum load was noted with repair. The repair tissue in the adult tissue had the highest degree of hypercellularity at the fifteen-week time point. Conclusions: Functional ligament healing depends on the level of skeletal maturity of the animal, with immature animals having a more productive healing response than mature animals. Clinical Relevance: As future investigations assess new techniques of ligament healing in animal models, skeletal maturity should be considered in the design and the interpretation of those experiments. PMID:20810854

Murray, Martha M.; Magarian, Elise M.; Harrison, Sophia L.; Mastrangelo, Ashley N.; Zurakowski, David; Fleming, Braden C.

2010-01-01

235

Comparison of anterior cruciate ligament reconstruction in male and female athletes using the patellar tendon and hamstring autografts  

Microsoft Academic Search

Despite the higher incidence of anterior cruciate ligament (ACL) injuries in female than in male athletes few authors have studied the effects of gender on the outcome of ACL reconstruction. This prospective study compared the results of ACL reconstruction using the patellar tendon and hamstring techniques in men and women. We prospectively followed 80 comparable athletes (46 males, 32 females)

Alberto Gobbi; Marcin Domzalski; Jose Pascual

2004-01-01

236

Reconstruction of the anterior cruciate ligament in the dogComparison of results obtained with three different porous synthetic materials  

Microsoft Academic Search

The anterior cruciate ligaments in 17 knees of 12 mongrel dogs were replaced with one of three porous minimally reactive prosthetic (synthetic) materials. The results show that while the porous materials support the ingrowth of fibrous tissue from the bone of the dog's knee, fatigue failure occurred before sufficient fibrous tissue was incorporated to reconstitute a functional ligament. Further laboratory

John F. Meyers; William A. Grana; Peggy A. Lesker

1979-01-01

237

Reconstruction of the anterior cruciate ligament with freeze dried fascia lata allografts in dogsA preliminary report  

Microsoft Academic Search

In 16 adult dogs the anterior cruciate ligament (ACL) was transected and then reconstructed using freeze dried fascia lata allografts. Eight of the dogs had the intraarticular graft passed through drill holes in the tibia and femur, while in the other eight dogs the graft was passed through a drill hole in the tibia and routed \\

Ralph J. Curtis; Jesse C. Delee; David J. Drez

1985-01-01

238

A bioabsorbable plug in bone-tendon-bone reconstruction of the anterior cruciate ligament: Introduction of a novel fixation technique  

Microsoft Academic Search

Purpose: Our aim was to compare the fixation strength of a novel plugging technique with that of the conventional interference technique in bone–patellar tendon–bone reconstruction of the anterior cruciate ligament. Type of Study: Randomized experimental study. Methods: Twenty matched pairs of porcine knees were randomly assigned to 2 groups. The bone block of the graft was secured in the femoral

Petteri Kousa; Teppo L. N. Järvinen; Pekka Kannus; Pia Ahvenjärvi; Auvo Kaikkonen; Markku Järvinen

2001-01-01

239

Regeneration of the semitendinosus and gracilis tendons following their transection for repair of the anterior cruciate ligament  

Microsoft Academic Search

Apparent regeneration of the tendons of the semiten dinosus and gracilis muscles after their use for anterior cruciate ligament reconstruction was noted during rou tine followup of 225 patients. From this group, four patients were selected for thorough examination, in cluding magnetic resonance imaging, electromyo graphic studies, strength testing, and clinical examina tion. The results demonstrate that these tendons ap

Mervyn J. Cross; Greg Roger; Ples Kujawa; Ian F. Anderson

1992-01-01

240

Septic arthritis of the knee following anterior cruciate ligament reconstruction: results of a survey of sports medicine fellowship directors  

Microsoft Academic Search

To determine the incidence of joint sepsis following anterior cruciate ligament (ACL) reconstruction and the prevailing attitudes toward its treatment, we surveyed the directors of Sports Medicine Fellowship programs about their practices in treating and preventing this complication. Of the 74 surgeons surveyed, 61 (82%) responded. These 61 surgeons performed an average of 98 ACL reconstructions yearly; 31 (51 %)

MJ Matava; TA Evans; RW Wright; RA Shively

1998-01-01

241

The Use of Cold Therapy After Anterior Cruciate Ligament ReconstructionA Prospective, Randomized Study and Literature Review  

Microsoft Academic Search

We performed a randomized, prospective study to as sess the effectiveness of postoperative cold therapy in patients who had anterior cruciate ligament reconstruc tions. Drain output, length of hospital stay, range of motion, and use of pain medication were all assessed. Patients were randomized into one of four groups after surgery. Group 1 patients had a cooling pad applied to

Gregory A. Konrath; Terrence Lock; Henry T. Goitz; Jeb Scheidler

1996-01-01

242

Effect of Electron Beam Irradiation on Biomechanical Properties of Patellar Tendon Allografts in Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background: Sterilization of anterior cruciate ligament (ACL) allografts is an important prerequisite to prevent disease transmission. However, mechanical tissue properties are compromised by most current sterilization procedures, so that uncompromised sterilization of allografts is difficult to achieve.Hypothesis\\/Purpose: The aim of this study was to evaluate the effect of the novel electron beam sterilization procedure on the biomechanical properties of human

Arnd T. Hoburg; Salahedeen Keshlaf; Tanja Schmidt; Mark Smith; Uwe Gohs; Carsten Perka; Axel Pruss; Sven Scheffler

2010-01-01

243

Torque-velocity relationships of the knee extensor and flexor muscles in individuals sustaining injuries of the anterior cruciate ligament  

Microsoft Academic Search

Muscle deficits in 58 patients with chronic anterior cruciate ligament (ACL) insufficiency were evaluated after completion of a 6 month rehabilitation program. Quadriceps and hamstring torques were measured on a modified Cybex II isokinetic dynamometer. Twenty- nine of our patients were tested just prior to undergoing ACL reconstruction, and patients who were continuing to tolerate their conditions served as controls.For

Sarah M. Murray; Russell F. Warren; James C. Otis; Michael Kroll; Thomas L. Wickiewicz

1984-01-01

244

A comparison of rabbit mesenchymal stem cells and anterior cruciate ligament fibroblasts responses on combined silk scaffolds  

Microsoft Academic Search

The aim of this study was to compare the cellular responses of bone marrow-derived mesenchymal stem cells (BMSCs) and anterior cruciate ligament fibroblasts (ACLFs) on combined silk scaffolds for ligament tissue engineering application. Rabbit BMSCs and ACLFs were isolated and cultured in vitro for two weeks after seeding on the silk scaffolds. Samples were evaluated and compared for their cellular

Haifeng Liu; Hongbin Fan; Siew L. Toh; James C. H. Goh

2008-01-01

245

Early active extension after anterior cruciate ligament reconstruction does not result in increased laxity of the knee  

Microsoft Academic Search

If permission of full active and passive extension immediately after an anterior cruciate ligament (ACL) reconstruction will increase the post-operative laxity of the knee has been a subject of discussion. We investigated whether a post-operative rehabilitation protocol including active and passive extension without any restrictions in extension immediately after an ACL reconstruction would increase the post-operative anterior–posterior knee laxity (A–P

Jonas Isberg; Eva Faxén; Sveinbjörn Brandsson; Bengt I. Eriksson; Johan Kärrholm; Jon Karlsson

2006-01-01

246

In Vivo Stability and Clinical Comparison of Anterior Cruciate Ligament Reconstruction Using Low or High Femoral Tunnel Positions  

Microsoft Academic Search

Background: Several biomechanical studies have supported placing the femoral tunnel at a low position (10 or 2 o’clock) to achieve anterior and rotational knee stabilities after anterior cruciate ligament (ACL) reconstruction. However, no firm consensus has been reached regarding the merits and demerits of ACL reconstruction using a low femoral tunnel versus a high femoral tunnel (11 or 1 o’clock).Hypothesis:

Jong Keun Seon; Sang Jin Park; Keun Bae Lee; Hyoung Yeon Seo; Myung Sun Kim; Eun Kyoo Song

2011-01-01

247

A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model  

Microsoft Academic Search

Similar-sized patellar tendon autografts and fresh-fro zen allografts were used to reconstruct the anterior cruciate ligament of one knee in 40 female goats. Evaluations of the reconstructions and contralateral controls at the 6-week and 6-month postoperative pe riods included anterior-posterior translation, mechanical properties determined during tensile failure tests, meas urement of cross-sectional area, histology, collagen fibril size and area distribution,

Douglas W. Jackson; Edward S. Grood; Jack D. Goldstein; Mark A. Rosen; Peter R. Kurzweil; John F. Cummings; Timothy M. Simon

1993-01-01

248

Arthroscopic Absorbable Suture Fixation for Tibial Spine Fractures  

PubMed Central

The purpose of this technical note and accompanying video is to describe a modified arthroscopic suture fixation technique to treat tibial spine avulsion fractures. Twenty-one patients underwent arthroscopic treatment for tibial spine avulsion with our technique; they were clinically and biomechanically evaluated at 2 years' follow-up and showed optimal clinical and radiographic outcomes. Repair with this arthroscopic technique provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the anterior cruciate ligament: suture methods based on the avulsed bone fragment are technically impossible, but sutures through the base of the ligament itself provide secure fixation, reducing the risks of comminution of the fracture fragment and eliminating the time for hardware removal. This arthroscopic technique restores the length and the integrity of the anterior cruciate ligament and provides a simplified, reproducible method of treating patients, including young patients, with low hardware costs in comparison to sutures using anchors or other hardware. PMID:24749022

Verdano, Michele Arcangelo; Pellegrini, Andrea; Lunini, Enricomaria; Tonino, Pietro; Ceccarelli, Francesco

2013-01-01

249

Biomechanical Evaluation of the Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction  

PubMed Central

Background Recently, many surgeons have chosen the quadriceps tendon (QT) as an autograft for anterior cruciate ligament (ACL) reconstruction. However, there have not been biomechanical studies that quantitatively evaluated knee function after reconstruction using a QT autograft. Purpose To measure the 6 degrees of freedom knee kinematics and in situ graft forces after reconstruction with a QT autograft compared with a quadrupled semitendinosus and gracilis (QSTG) tendon autograft. Study Design Controlled laboratory study. Methods Ten human cadaveric knees (age, 54–64 years) were tested in 3 conditions: (1) intact, (2) ACL deficient, and (3) after ACL reconstruction using a QT or QSTG autograft. With use of a robotic/universal force-moment sensor testing system, knee kinematics and in situ forces in the ACL and autografts were obtained at 5 knee flexion angles under externally applied loads: (1) 134-N anterior tibial load, (2) 134-N anterior tibial load with 200-N axial compression, and (3) 10-N·m valgus and 5-N·m internal tibial torque. Results Under the anterior tibial load, both autografts restored anterior tibial translation to within 2.5 mm of the intact knee and in situ forces to within 20 N of the intact ACL at 15°, 30°, and 60°. Adding compression did not change these findings. With the combined rotatory load, the anterior tibial translation and graft in situ forces were again not significantly different from the intact ACL. There were no significant differences between the grafts under any experimental condition. Conclusion Reconstruction of the ACL with a QT autograft restored knee function to similar levels as that reconstructed with a QSTG autograft under loads simulating clinical examinations. Clinical Relevance The positive biomechanical results of this cadaveric study lend support to the use of a QT autograft for ACL reconstruction, as it could restore knee function immediately after surgery under applied loads that mimic clinical examinations. PMID:24401682

Sasaki, Norihiro; Farraro, Kathryn F.; Kim, Kwang E.; Woo, Savio L-Y.

2014-01-01

250

Visualization of Torn Anterior Cruciate Ligament Using 3-Dimensional Computed Tomography  

PubMed Central

Recently, a remnant-preserving anterior cruciate ligament (ACL) reconstruction technique has been developed. However, the preoperative condition of remnant ACL is occasionally difficult to evaluate by magnetic resonance imaging. The purpose of this study is to evaluate the accuracy of pre-operative visualization of remnant ACL using three-dimensional computed tomography (3D-CT). The remnant ACL in 25 patients was examined by 3DCT before ACL reconstruction surgery. Findings on 3D-CT images and arthroscopy were compared. The 3D-CT images were classified into 4 groups: Group A, remnant fibers attached to the posterior cruciate ligament (PCL); Group B, those located between the PCL and the lateral wall; Group C, those attached to the lateral wall; and Group D, no identifiable remnant fibers on the tibial side. These groups were made up of 4, 3, 9 and 9 patients, respectively. Findings on 3D-CT images were identical to those during arthroscopy in 20 of 25 cases (80%). Remnant ACL can be accurately evaluated using 3D-CT in 80% of cases of torn ACL. This novel method is a useful technique for pre-operative assessment of remnant ACL. PMID:24191182

Uozumi, Hiroaki; Aizawa, Toshimi; Sugita, Takehiko; Kunii, Tomonori; Abe, Shun; Itoi, Eiji

2013-01-01

251

Development of a silk and collagen fiber scaffold for anterior cruciate ligament reconstruction.  

PubMed

The objective of this study was to determine a silk-collagen fiber ratio for an anterior cruciate ligament (ACL) reconstruction composite scaffold device. Composite fiber scaffolds with silk volumes ?14 % and collagen volume <86 % demonstrated comparable or greater initial ultimate tensile stress relative to the human ACL. Silk scaffolds implanted subcutaneously and intraarticularly in rabbits demonstrated an 84 and 92 % reduction in strength with a 26 and 22 % reduction in volume after 8 weeks, respectively. The mechanical degradation findings of this preliminary study suggest that a composite scaffold with an initial UTS value of at least 129 MPa, or roughly a 48:52 silk to collagen volume ratio meets the minimal mechanical requirements necessary to proceed to a functional ACL reconstruction study in vivo. PMID:23053810

Panas-Perez, Eleni; Gatt, Charles J; Dunn, Michael G

2013-01-01

252

X-ray computed tomography of the anterior cruciate ligament and patellar tendon  

PubMed Central

Summary The effect of phosphotungstic acid (PTA) and iodine solution (IKI) staining was investigated as a method of enhancing contrast in the X-ray computed tomography of porcine anterior cruciate ligaments (ACL) and patellar tendons (PT). We show that PTA enhanced surface contrast, but was ineffective at penetrating samples, whereas IKI penetrated more effectively and enhanced contrast after 70 hours of staining. Contrast enhancement was compared when using laboratory and synchrotron based X-ray sources. Using the laboratory source, PT fascicles were tracked and their alignment was measured. Individual ACL fascicles could not be identified, but identifiable features were evident that were tracked. Higher resolution scans of fascicle bundles from the PT and ACL were obtained using synchrotron imaging techniques. These scans exhibited greater contrast between the fascicles and matrix in the PT sample, facilitating the identification of the fascicle edges; however, it was still not possible to detect individual fascicles in the ACL. PMID:25332942

Shearer, Tom; Rawson, Shelley; Castro, Simon Joseph; Balint, Richard; Bradley, Robert Stephen; Lowe, Tristan; Vila-Comamala, Joan; Lee, Peter David; Cartmell, Sarah Harriet

2014-01-01

253

Acute Concomitant Anterior Cruciate Ligament and Patellar Tendon Tears in a Non-dislocated Knee  

PubMed Central

Anterior cruciate ligament (ACL) tears are common and may occur in isolation or with other internal derangements of the joint. Tears of the patellar tendon (PT) occur less frequently and are rarely associated with intra-articular pathology. Acute combined tears of both the ACL and PT are known complications of high-energy traumatic knee dislocations. We present a case of an acute concomitant ACL and PT tears in a low-energy non-dislocated knee. To our knowledge, this injury has only been described in a limited number of case reports in the orthopedic literature. We present the imaging findings of this combined injury and discuss the importance of magnetic resonance (MR) in diagnosis. PMID:22439127

Wissman, Robert D.; Vonfischer, Nathaniel; Kempf, Kari

2012-01-01

254

Synovial osteochondroma originating from the synovium of the anterior cruciate ligament  

PubMed Central

Primary synovial osteochondromatosis is a rarely seen disorder of the synovium in any joints. Among reported cases of knee osteochondromatosis, those originating from the anterior cruciate ligament (ACL) are very rare. We report an unusual case of primary synovial osteochondromatosis. A 27-year-old woman complained of a restricted range of right-knee motion and pain when walking. With locking symptoms similar to those associated with a meniscus bucket handle tear. Although plain radiograph and MRI showed normal appearance, diagnostic arthroscopy revealed the curious appearance of a huge mass seated on ACL. In addition, the sign of proliferation of synovium and cartilaginous tissues were apparent. The ACL mass has been removed while preserving the ACL fibres. Histological examination confirmed a diagnosis of osteochondromatosis. To the best of our knowledge, this is the first report to describe synovial osteochondromatosis originating from ACL fibres and has been resected while preserving the ACL. PMID:23345533

AlAqeel, Motaz Abdulrhuman; Al-Ahaideb, Abdulaziz

2013-01-01

255

Factors affecting return to play after anterior cruciate ligament reconstruction: a review of the current literature.  

PubMed

Anterior cruciate ligament reconstruction has been reported to produce normal or near-normal knee results in > 90% of patients. A recent meta-analysis suggested that, despite normal or near-normal knees, many athletes do not return to sports. Rates and timing of return to competitive athletics are quite variable depending on the graft type, the age of the patient, the sport, and the level of play. Even when athletes do return to play, often they do not return to their previous level. Graft failure, subjective physical factors, and psychological factors, including fear of reinjury and lack of motivation, appear to play a large role in patients' ability to return to sporting activities. PMID:25419890

Bauer, Matthew; Feeley, Brian T; Wawrzyniak, John R; Pinkowsky, Gregory; Gallo, Robert A

2014-11-01

256

Three-dimensional engineered bone-ligament-bone constructs for anterior cruciate ligament replacement.  

PubMed

The anterior cruciate ligament (ACL), a major stabilizer of the knee, is commonly injured. Because of its intrinsic poor healing ability, a torn ACL is usually reconstructed by a graft. We developed a multi-phasic, or bone-ligament-bone, tissue-engineered construct for ACL grafts using bone marrow stromal cells and sheep as a model system. After 6 months in vivo, the constructs increased in cross section and exhibited a well-organized microstructure, native bone integration, a functional enthesis, vascularization, innervation, increased collagen content, and structural alignment. The constructs increased in stiffness to 52% of the tangent modulus and 95% of the geometric stiffness of native ACL. The viscoelastic response of the explants was virtually indistinguishable from that of adult ACL. These results suggest that our constructs after implantation can obtain physiologically relevant structural and functional characteristics comparable to those of adult ACL. They present a viable option for ACL replacement. PMID:21902608

Ma, Jinjin; Smietana, Michael J; Kostrominova, Tatiana Y; Wojtys, Edward M; Larkin, Lisa M; Arruda, Ellen M

2012-01-01

257

Is magnetic resonance imaging reliable for the evaluation of the ruptured or healed anterior cruciate ligament?  

PubMed

Magnetic resonance imaging (MRI) is the preferred imaging technique to evaluate the intact, ruptured or healed anterior cruciate ligament (ACL). However, its effectiveness in the diagnosis of chronic tears with synovialization has not been searched. During conservative treatment of torn ACL, there is a reparative process with proliferation of synovial scar tissue which may produce a bridge. This healing, so called synovialization, may cause ACL to be misdiagnosed as intact on MRI. This is true for old ruptures of ACL. Magnetic resonance imaging is reliable in the evaluation of acute ACL ruptures. However, MRI is not reliable to evaluate the stability of the healed ACL after conservative treatment, and the ruptures due to degenerated ACLs. PMID:25741919

Atik, O ?ahap; Çavu?o?lu, A Turgay; Ayano?lu, Tacettin

2015-04-01

258

Anterior cruciate ligament reconstruction best practice: A review of graft choice.  

PubMed

There is much literature about differing grafts used in anterior cruciate ligament (ACL) reconstruction. Much of this is of poor quality and of a low evidence base. We review and summarise the literature looking at the four main classes of grafts used in ACL reconstruction; bone-patella tendon-bone, hamstrings, allograft and synthetic grafts. Each graft has the evidence for its use reviewed and then compared, where possible, to the others. We conclude that although there is no clear "best" graft, there are clear differences between the differing graft choices. Surgeon's need to be aware of the evidence behind these differences, in order to have appropriate discussions with their patients, so as to come to an informed choice of graft type to best suit each individual patient and their requirements. PMID:24649411

Shaerf, Daniel A; Pastides, Philip S; Sarraf, Khaled M; Willis-Owen, Charles A

2014-01-18

259

Lessons Learnt from an Atypical Mycobacterium Infection Post-Anterior Cruciate Ligament Reconstruction  

PubMed Central

Infections following anterior cruciate ligament reconstruction are rare, with no previous reports citing Mycobacterium abscessus as the culprit pathogen. A 22-year-old man presented twice over three years with a painful discharging sinus over his right tibia tunnel site necessitating repeated arthroscopy and washout, months of antibiotic therapy, and ultimately culminating in the removal of the implants. In both instances, M. abscessus was present in the wound cultures, along with a coinfection of Staphyloccocus aureus during the second presentation. Though rare, M. abscessus is an important pathogen to consider in postoperative wounds presenting with chronic discharging sinuses, even in healthy non-immunocompromised patients. This case illustrates how the organism can cause an indolent infection, and how the removal of implants can be necessary to prevent the persistence of infection. Coinfection with a second organism is not uncommon and necessitates a timely change in treatment regime as well. PMID:25729530

Yee Han, Dave Lee

2015-01-01

260

Ligament Tissue Engineering and Its Potential Role in Anterior Cruciate Ligament Reconstruction  

PubMed Central

Tissue engineering is an emerging discipline that combines the principle of science and engineering. It offers an unlimited source of natural tissue substitutes and by using appropriate cells, biomimetic scaffolds, and advanced bioreactors, it is possible that tissue engineering could be implemented in the repair and regeneration of tissue such as bone, cartilage, tendon, and ligament. Whilst repair and regeneration of ligament tissue has been demonstrated in animal studies, further research is needed to improve the biomechanical properties of the engineered ligament if it is to play an important part in the future of human ligament reconstruction surgery. We evaluate the current literature on ligament tissue engineering and its role in anterior cruciate ligament reconstruction. PMID:22253633

Yates, E. W.; Rupani, A.; Foley, G. T.; Khan, W. S.; Cartmell, S.; Anand, S. J.

2012-01-01

261

Regeneration of the anterior cruciate ligament: Current strategies in tissue engineering  

PubMed Central

Recent advancements in the field of musculoskeletal tissue engineering have raised an increasing interest in the regeneration of the anterior cruciate ligament (ACL). It is the aim of this article to review the current research efforts and highlight promising tissue engineering strategies. The four main components of tissue engineering also apply in several ACL regeneration research efforts. Scaffolds from biological materials, biodegradable polymers and composite materials are used. The main cell sources are mesenchymal stem cells and ACL fibroblasts. In addition, growth factors and mechanical stimuli are applied. So far, the regenerated ACL constructs have been tested in a few animal studies and the results are encouraging. The different strategies, from in vitro ACL regeneration in bioreactor systems to bio-enhanced repair and regeneration, are under constant development. We expect considerable progress in the near future that will result in a realistic option for ACL surgery soon. PMID:25621217

Nau, Thomas; Teuschl, Andreas

2015-01-01

262

Military movement training program improves jump-landing mechanics associated with anterior cruciate ligament injury risk.  

PubMed

As part of the physical education program at the United States Military Academy, all cadets complete a movement training course designed to develop skills and improve performance in military-related physical tasks as well as obstacle navigation. The purpose of this study was to determine if completion of this course would also result in changes in jump-landing technique that reduce the risk of anterior cruciate ligament (ACL) injury. Analysis of landing mechanics on a two-footed jump landing from a height of 30 cm with a three-dimensional motion capture system synchronized with two force plates revealed both positive and negative changes. Video assessment using the Landing Error Scoring System (LESS) revealed an overall improved landing technique (p=.001) when compared to baseline assessments. The studied military movement course appears to elicit mixed but overall improved lower extremity jump-landing mechanics associated with risk for ACL injury. PMID:23449058

Owens, Brett D; Cameron, Kenneth L; Duffey, Michele L; Vargas, Donna; Duffey, Michael J; Mountcastle, Sally B; Padua, Darin; Nelson, Bradley J

2013-01-01

263

ANTERIOR CRUCIATE LIGAMENT INJURY DIAGNOSIS AND MANAGEMENT IN A PEDIATRIC PATIENT: A CASE REPORT  

PubMed Central

The management of the skeletally immature athlete sustaining injury to the anterior cruciate ligament and other knee structures provides multiple challenges for both the treating clinicians and parents of the injured child. The diagnostic process and subsequent decision making present additional complexities because of the developmental anatomy and the potential for disturbance of normal growth patterns by some surgical interventions. In the following case report, the course to appropriate management of a young athlete is detailed, including the contributions of imaging results. The reconstructive options available to orthopedic surgeons and the patient's post?operative progression are also briefly discussed. Rehabilitation practitioners require an understanding of the unique issues present when providing care for pediatric and adolescent athletes with knee injuries in order to assist in optimal decision making in the phases during which they are involved. Level of Evidence: 5 (Single Case Report) PMID:23316431

Duby, Cherie

2012-01-01

264

Regeneration of the anterior cruciate ligament: Current strategies in tissue engineering.  

PubMed

Recent advancements in the field of musculoskeletal tissue engineering have raised an increasing interest in the regeneration of the anterior cruciate ligament (ACL). It is the aim of this article to review the current research efforts and highlight promising tissue engineering strategies. The four main components of tissue engineering also apply in several ACL regeneration research efforts. Scaffolds from biological materials, biodegradable polymers and composite materials are used. The main cell sources are mesenchymal stem cells and ACL fibroblasts. In addition, growth factors and mechanical stimuli are applied. So far, the regenerated ACL constructs have been tested in a few animal studies and the results are encouraging. The different strategies, from in vitro ACL regeneration in bioreactor systems to bio-enhanced repair and regeneration, are under constant development. We expect considerable progress in the near future that will result in a realistic option for ACL surgery soon. PMID:25621217

Nau, Thomas; Teuschl, Andreas

2015-01-18

265

Ligament tissue engineering and its potential role in anterior cruciate ligament reconstruction.  

PubMed

Tissue engineering is an emerging discipline that combines the principle of science and engineering. It offers an unlimited source of natural tissue substitutes and by using appropriate cells, biomimetic scaffolds, and advanced bioreactors, it is possible that tissue engineering could be implemented in the repair and regeneration of tissue such as bone, cartilage, tendon, and ligament. Whilst repair and regeneration of ligament tissue has been demonstrated in animal studies, further research is needed to improve the biomechanical properties of the engineered ligament if it is to play an important part in the future of human ligament reconstruction surgery. We evaluate the current literature on ligament tissue engineering and its role in anterior cruciate ligament reconstruction. PMID:22253633

Yates, E W; Rupani, A; Foley, G T; Khan, W S; Cartmell, S; Anand, S J

2012-01-01

266

Most british surgeons would consider using a tissue-engineered anterior cruciate ligament: a questionnaire study.  

PubMed

Donor site morbidity, poor graft site integration, and incorrect mechanical performance are all common problems associated with autografts for anterior cruciate ligament (ACL) reconstructions. A tissue-engineered (TE) ligament has the potential to overcome these problems. We produced an online questionnaire relating to tissue engineering of the ACL to obtain input from practising clinicians who currently manage these injuries. 300 British orthopaedic surgeons specialising in knee surgery and soft tissue injury were invited to participate. 86% of surgeons would consider using a TE ACL if it were an option, provided that it showed biological and mechanical success, if it significantly improved the patient satisfaction (63%) or shortened surgical time (62%). 76% felt that using a TE ACL would be more appropriate than a patellar tendon, hamstring, or quadriceps autograft. Overall, most surgeons would be prepared to use a TE ACL if it were an improvement over the current techniques. PMID:22567023

Rathbone, Sarah; Maffulli, Nicola; Cartmell, Sarah H

2012-01-01

267

Correlation between Femoral Guidewire Position and Tunnel Communication in Double Bundle Anterior Cruciate Ligament Reconstruction  

PubMed Central

Purpose The object of this study was to determine the shortest possible distances of antero-medial (AM) and postero-lateral (PL) guide wire tunnel positions required to prevent femoral bone tunnel communication in double-bundle anterior cruciate ligament (ACL) reconstruction using human cadaver knees. Materials and Methods The centers of femoral AM and PL bundles of 16 cadaveric knees were drilled with guide wires and the distances of guide wires, were measured upon entrance into the bone. Femoral tunnel drilling was performed using transportal technique. The diameters of AM and PL graft were 8 mm and 6 mm, respectively. CT scans were taken on each knee, and 3-dimensional models were constructed to identify the femoral tunnel position and to create AM and PL tunnel virtual cylinders. Thickness of the bone bridge between the two tunnels was measured. Results In four out of six specimens, in which the guide wires were placed at less than or equal to 9 mm, communication was noted. In specimens with guide wires placed at distances greater than or equal to 10 mm, communication was not noted. The two groups showed a statistically significant difference (p=0.008). In cases where the distance between the AM and PL femoral tunnel guide wires was 12 mm, the bone bridge thickness was greater than 2 mm along the tunnel. Conclusion The technique for double bundle-anterior cruciate ligament (DB-ACL) reconstruction that we show here can avoid bone tunnel communication when AM and PL femoral guide wires are placed at least 10 mm apart, and 12 mm should be kept to preserve 2 mm bone bridge thickness. PMID:25323896

Lee, Sang Hyuk; Choi, Jun Young; Kim, Dong Hee; Kang, Bun Jung; Nam, Dae Cheol; Yoon, Hong Kwon

2014-01-01

268

Variables Associated With Return to Sport Following Anterior Cruciate Ligament Reconstruction: A Systematic Review  

PubMed Central

Background As one of the purposes of anterior cruciate ligament reconstruction (ACLR) is to return athletes to their pre-injury activity level, it is critical to understand variables influencing return to sport. Associations between return to sport and variables representing knee impairment, function and psychological status have not been well studied in athletes following ACLR. Purpose The purpose of this review is to summarize the literature reporting on variables proposed to be associated with return to sport following anterior cruciate ligament reconstruction. Study Design Systematic Review Methods Medline, Embase, CINAHL and Cochrane databases were searched for articles published before November 2012. Articles included in this review met these criteria: 1) included patients with primary ACLR, 2) reported at least one knee impairment, function or psychological measure, 3) reported a return to sport measure and 4) analyzed the relationship between the measure and return to sport. Results Weak evidence existed in sixteen articles suggesting variables associated with return to sport included higher quadriceps strength, less effusion, less pain, greater tibial rotation, higher Marx Activity score, higher athletic confidence, higher pre-operative knee self-efficacy, lower kinesiophobia and higher pre-operative self-motivation. Conclusion Weak evidence supports an association between knee impairment, functional, and psychological variables and return to sport. Current return to sport guidelines should be updated to reflect all variables associated with return to sport. Utilizing evidence-based return to sport guidelines following ACLR may ensure athletes are physically and psychologically capable of sports participation, which may reduce re-injury rates and the need for subsequent surgery. PMID:24124040

Czuppon, Sylvia; Racette, Brad A.; Klein, Sandra E.; Harris-Hayes, Marcie

2014-01-01

269

Mechanical stretch increases CCN2/CTGF expression in anterior cruciate ligament-derived cells  

SciTech Connect

Highlights: {yields} CCN2/CTGF localizes to the ligament-to-bone interface, but is not to the midsubstance region of human anterior cruciate ligament (ACL). {yields} Mechanical stretch induces higher increase of CCN2/CTGF gene expression and protein secretion in ACL interface cells compared with ACL midsubstance cells. {yields} CCN2/CTGF treatment stimulates the proliferation of ACL interface cells. -- Abstract: Anterior cruciate ligament (ACL)-to-bone interface serves to minimize the stress concentrations that would arise between two different tissues. Mechanical stretch plays an important role in maintaining cell-specific features by inducing CCN family 2/connective tissue growth factor (CCN2/CTGF). We previously reported that cyclic tensile strain (CTS) stimulates {alpha}1(I) collagen (COL1A1) expression in human ACL-derived cells. However, the biological function and stress-related response of CCN2/CTGF were still unclear in ACL fibroblasts. In the present study, CCN2/CTGF was observed in ACL-to-bone interface, but was not in the midsubstance region by immunohistochemical analyses. CTS treatments induced higher increase of CCN2/CTGF expression and secretion in interface cells compared with midsubstance cells. COL1A1 expression was not influenced by CCN2/CTGF treatment in interface cells despite CCN2/CTGF stimulated COL1A1 expression in midsubstance cells. However, CCN2/CTGF stimulated the proliferation of interface cells. Our results suggest that distinct biological function of stretch-induced CCN2/CTGF might regulate region-specific phenotypes of ACL-derived cells.

Miyake, Yoshiaki [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan) [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Furumatsu, Takayuki, E-mail: matino@md.okayama-u.ac.jp [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)] [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Kubota, Satoshi; Kawata, Kazumi [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)] [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Ozaki, Toshifumi [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)] [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Takigawa, Masaharu [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)] [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)

2011-06-03

270

A Multisport Epidemiologic Comparison of Anterior Cruciate Ligament Injuries in High School Athletics  

PubMed Central

Background: The knee joint is the second most commonly injured body site after the ankle and the leading cause of sport-related surgeries. Knee injuries, especially of the anterior cruciate ligament (ACL), are among the most economically costly sport injuries, frequently requiring expensive surgery and rehabilitation. Objective: To investigate the epidemiology of ACL injuries among high school athletes by sport and sex. Design: Descriptive epidemiology study. Main Outcome Measure(s): Using an Internet-based data-collection tool, Reporting Information Online (RIO), certified athletic trainers from 100 nationally representative US high schools reported athlete-exposure and injury data for athletes from 9 sports during the 2007/08–2011/12 academic years. The outcome of interest in this study was ACL injuries. Results: During the study period, 617 ACL injuries were reported during 9?452?180 athlete exposures (AEs), for an injury rate of 6.5 per 100?000 AEs. Nationally, in the 9 sports studied, an estimated 215?628 ACL injuries occurred during the study period. The injury rate was higher in competition (17.6) than practice (2.4; rate ratio [RR] = 7.3, 95% confidence interval [CI] = 6.08, 8.68). Girls' soccer had the highest injury rate (12.2) followed by boys' football (11.1), with boys' basketball (2.3) and boys' baseball (0.7) having the lowest rates. In sex-comparable sports, girls had a higher rate (8.9) than boys (2.6; RR = 3.4, 95% CI = 2.64, 4.47). Overall, 76.6% of ACL injuries resulted in surgery. The most common mechanisms of injury were player-to-player contact (42.8%) and no contact (37.9%). Conclusions: Anterior cruciate ligament injury rates vary by sport, sex, and type of exposure. Recognizing such differences is important when evaluating the effectiveness of evidence-based, targeted prevention efforts. PMID:24143905

Joseph, Allan M.; Collins, Christy L.; Henke, Natalie M.; Yard, Ellen E.; Fields, Sarah K.; Comstock, R. Dawn

2013-01-01

271

Optimization of culture conditions for stem cells derived from human anterior cruciate ligament and bone marrow.  

PubMed

Tissue engineering with stem cells is a fascinating approach for treating anterior cruciate ligament (ACL) injuries. In our previous study, stem cells isolated from the human anterior cruciate ligament were shown to possess extensive proliferation and differentiation capabilities when treated with specific growth factors. However, optimal culture conditions and the usefulness of fetal bovine serum (FBS) as a growth factor in in vitro culture systems are yet to be determined. In this study, we compared the effects of different culture media containing combinations of various concentrations of FBS and the growth factors basic fibroblastic growth factor (bFGF) and transforming growth factor-?1 (TGF-?1) on the proliferation and differentiation of ligament-derived stem cells (LSCs) and bone marrow mesenchymal stem cells (BMSCs). We found that ?-MEM plus 10% FBS and bFGF was able to maintain both LSCs and BMSCs in a relatively undifferentiated state but with lower major extracellular matrix (ECM) component gene expression and protein production, which is beneficial for stem cell expansion. However, the differentiation and proliferation potentials of LSCs and BMSCs were increased when cultured in MesenPRO, a commercially available stem cell medium containing 2% FBS. MesenPRO in conjunction with TGF-?1 had the greatest ability to induce the differentiation of BMSCs and LSCs to ligament fibroblasts, which was evidenced by the highest ligamentous ECM gene expression and protein production. These results indicate that culture media and growth factors play a very important role in the success of tissue engineering. With ?-MEM plus 10% FBS and bFGF, rapid proliferation of stem cells can be achieved. In this study, MesenPRO was able to promote differentiation of both LSCs and BMSCs to ligament fibroblasts. Differentiation was further increased by TGF-?1. With increasing understanding of the effects of different culture media and growth factors, manipulation of stem cells in the desired direction for ligament tissue engineering can be achieved. PMID:23582177

Cheng, Ming-Te; Liu, Chien-Lin; Chen, Tain-Hsiung; Lee, Oscar K

2014-01-01

272

Effectiveness of a Neuromuscular and Proprioceptive Training Program in Preventing Anterior Cruciate Ligament Injuries in Female Athletes2Year Follow-up  

Microsoft Academic Search

Background: Among female athletes it has not been established whether a neuromuscular and proprioceptive sports-specific training program will consistently reduce the incidence of anterior cruciate ligament injuries.Purpose: To determine whether a neuromuscular and proprioceptive performance program was effective in decreasing the incidence of anterior cruciate ligament injury within a select population of competitive female youth soccer players.Study Design: Cohort study;

Bert R. Mandelbaum; Holly J. Silvers; Diane S. Watanabe; John F. Knarr; Stephen D. Thomas; Letha Y. Griffin; Donald T. Kirkendall; William Garrett

2005-01-01

273

Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: a systematic review and meta-analysis.  

PubMed

Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined. PMID:25547070

Bates, Nathaniel A; Myer, Gregory D; Shearn, Jason T; Hewett, Timothy E

2015-01-01

274

Arthroscopic Repair of Inferior Labrum From Anterior to Posterior Lesions Associated With Multidirectional Instability of the Shoulder  

PubMed Central

Multidirectional instability (MDI) of the shoulder may arise spontaneously; however, recent evidence suggests that traumatic events may play a role in this syndrome. Variable degrees of injury around the circumference of the glenoid have been reported, ranging from Bankart and Kim lesions to 270° of injury and even 360° of injury. Hyperabduction injury may cause inferior subluxation of the shoulder and result in traumatic isolated injury to the inferior labrum from anterior to posterior. This particular lesion spans approximately 180° of the inferior hemisphere and may lead to symptomatic MDI. In contrast to open or arthroscopic plication procedures for atraumatic MDI without labral injury, the goal in these cases is anatomic arthroscopic repair of the inferior labrum tear without the need for capsular plication, volume reduction, or rotator interval closure. PMID:25685683

Burt, David M.

2014-01-01

275

In vivo tensile behavior of a four-bundle hamstring graft as a replacement for the anterior cruciate ligament.  

PubMed

The purpose of this study was to measure the in vivo tensile behavior of a double-looped semitendinosus and gracilis graft used to reconstruct a torn anterior cruciate ligament in the human knee. In 14 subjects, intraoperative tension was measured for each of the four graft bundles during passive motion from 0 to 90 degrees of flexion. Two hypotheses were tested: (a) the peak tension carried by each of the four bundles was equal during passive motion, and (b) the mechanics of the bundles mimicked the functional bands of the native anterior cruciate ligament. The total tension was also calculated and used to determine strength requirements for fixation devices. The peak tensions of the four bundles during passive motion were not equal; however, enough tension was present in each bundle that load-sharing occurred between bundles. The pattern of tension between the anterior and posterior bundles mimicked the reciprocating load-sharing behavior of the functional bands of the native anterior cruciate ligament. Reciprocal tensile behavior was consistently achieved with the use of a single femoral tunnel centered on the most isometric line without the need for two separate femoral sockets. The maximum total tension was 296 N; this was nearly equal to the strength of one commonly used fixation device. PMID:9379263

Wallace, M P; Howell, S M; Hull, M L

1997-07-01

276

Arthroscopy-assisted anterior cruciate ligament reconstruction with patellar tendon or hamstring autografts.  

PubMed

Isolated ACL reconstructions were performed in 138 patients between 1994 and 1998. Patellar bone-patellar tendon-bone, and hamstring tendon autografts were used in 88 patients, and allografts were used in 50 patients. Eighty-eight knees of 88 patients with autograft reconstructions (17 female, 71 male) were included in this study and evaluation of the patients with allograft reconstruction reported separately. The mean age at the time of the operation was 32 years. All ACL reconstructions were performed arthroscopically. Twenty-seven bone-patellar tendon-bone, and 61 hamstring tendon autografts were used. The mean follow-up was 29 months. In the postoperative course the Lachman test was negative in 62 patients, 1+ in 22 patients, and 2+ in 4 patients. In 17 patients, anterior drawer sign were 1+ in comparison to the contralateral side. Pivot shift test was moderately positive only in 5 cases in the bone-patellar tendon-bone and hamstring tendon autograft groups postoperatively. There were 3 patients with subjective "giving way" symptoms. Second look arthroscopy revealed rupture of the neo-ligament. Arthroscopic washout and debridement were performed, and no revision ligamentoplasties were performed. Two of these patients improved with accelerated proprioceptive physical therapy, and one had to decrease his previous level of activity. There were no cases of arthrofibrosis, infection, or extension lag. Clinical results of patellar bone-tendon-bone and hamstring groups did not show any significant clinical difference. Avoiding the disturbance of the extensor mechanism of the knee is probably the most significant advantage of the hamstring autograft. PMID:10983256

Doral, M N; Leblebicioglu, G; Atay, O A; Baydar, M L; Tetik, O; Atik, S

2000-01-01

277

Clinically Relevant Injury Patterns After an Anterior Cruciate Ligament Injury Provide Insight Into Injury Mechanisms  

PubMed Central

Background The functional disability and high costs of treating anterior cruciate ligament (ACL) injuries have generated a great deal of interest in understanding the mechanism of noncontact ACL injuries. Secondary bone bruises have been reported in over 80% of partial and complete ACL ruptures. Purpose The objectives of this study were (1) to quantify ACL strain under a range of physiologically relevant loading conditions and (2) to evaluate soft tissue and bony injury patterns associated with applied loading conditions thought to be responsible for many noncontact ACL injuries. Study Design Controlled laboratory study. Methods Seventeen cadaveric legs (age, 45 ± 7 years; 9 female and 8 male) were tested utilizing a custom-designed drop stand to simulate landing. Specimens were randomly assigned between 2 loading groups that evaluated ACL strain under either knee abduction or internal tibial rotation moments. In each group, combinations of anterior tibial shear force, and knee abduction and internal tibial rotation moments under axial impact loading were applied sequentially until failure. Specimens were tested at 25° of flexion under simulated 1200-N quadriceps and 800-N hamstring loads. A differential variable reluctance transducer was used to calculate ACL strain across the anteromedial bundle. A general linear model was used to compare peak ACL strain at failure. Correlations between simulated knee injury patterns and loading conditions were evaluated by the ?2 test for independence. Results Anterior cruciate ligament failure was generated in 15 of 17 specimens (88%). A clinically relevant distribution of failure patterns was observed including medial collateral ligament tears and damage to the menisci, cartilage, and subchondral bone. Only abduction significantly contributed to calculated peak ACL strain at failure (P = .002). While ACL disruption patterns were independent of the loading mechanism, tibial plateau injury patterns (locations) were significantly (P = .002) dependent on the applied loading conditions. Damage to the articular cartilage along with depression of the midlateral tibial plateau was primarily associated with knee abduction moments, while cartilage damage with depression of the posterolateral tibial plateau was primarily associated with internal tibial rotation moments. Conclusion The current findings demonstrate the relationship between the location of the tibial plateau injury and ACL injury mechanisms. The resultant injury locations were similar to the clinically observed bone bruises across the tibial plateau during a noncontact ACL injury. These findings indicate that abduction combined with other modes of loading (multiplanar loading) may act to produce ACL injuries. Clinical Relevance A better understanding of ACL injury mechanisms and associated risk factors may improve current preventive, surgical, and rehabilitation strategies and limit the risk of ACL and secondary injuries, which may in turn minimize the future development of posttraumatic osteoarthritis of the knee. PMID:23144366

Levine, Jason W.; Kiapour, Ata M.; Quatman, Carmen E.; Wordeman, Samuel C.; Goel, Vijay K.; Hewett, Timothy E.; Demetropoulos, Constantine K.

2014-01-01

278

Nutrition of the anterior cruciate ligament. Effects of continuous passive motion  

SciTech Connect

Twelve freshly killed mature male rabbits were used to study the effects of continuous passive motion (CPM) on regional and overall nonvascular nutritional pathways of the anterior cruciate ligament (ACL). One hundred fifty microcuries of /sup 35/S-sulfate was injected intraarticularly into each knee joint. The right knee underwent CPM for 1 hour, while the left knee remained immobilized. Both knee joints were then isolated and immediately frozen. The ACLs were removed while still mostly frozen, and sectioned into anterior, middle, and posterior thirds for the six rabbits in Group 1, and proximal, middle, and distal thirds for the six rabbits in Group 2. In addition, quadriceps tendon samples were harvested from each limb of three rabbits. After appropriate processing, all samples were counted in a scintillation counter, and counts per minute per milligram of tissue were calculated. There was significantly higher uptake in rest extremity ACLs compared to CPM extremity ACLs (P = 0.0001). No significant difference was demonstrated in regional uptake comparing respective thirds of the ACL in either Group 1 or Group 2. Quadriceps tendon uptake trended higher in the limbs exposed to CPM compared to those maintained at rest (P = 0.14). The ACL uses diffusion as a primary nutrient pathway. CPM does not increase nutrient uptake by the ACL in this avascular model, but CPM may facilitate transport of metabolites out of the joint. No regional differences in uptake within the ACL occurred in either group.

Skyhar, M.J.; Danzig, L.A.; Hargens, A.R.; Akeson, W.H.

1985-11-01

279

Adolescent Differences in Knee Stability Following Computer-Assisted Anterior Cruciate Ligament Reconstruction  

PubMed Central

Anterior cruciate ligament (ACL) surgery is being increasingly performed in the adolescent population. Computer navigation offers a reliable way to quantitatively measure knee stability during ACL reconstruction. A retrospective review of all adolescent patients (<18 years old) who underwent computer-assisted primary single bundle ACL reconstruction by a single surgeon from 2007 to 2012 was performed. The average age was 15.8 years (SD 3.3). Female adolescents were found to have higher internal rotation than male adolescents both pre- (25.6° vs 21.7°, P=0.026) and post-reconstruction (20.1° vs 15.1°, P=0.005). Compared to adults, adolescents demonstrated significantly higher internal rotation both pre- (23.3° vs 21.5°, P=0.047) and post-reconstruction (17.1° vs 14.4°, P=0.003). They also had higher total rotation both pre- (40.9° vs 38.4°, P=0.02) and post-reconstruction when compared to adults (31.56° vs 28.67°, P=0.005). In adolescent patients, anterior translation was corrected more than rotation. Females had higher pre- and residual post-reconstruction internal rotation compared to males. When compared to adults, adolescents had increased internal rotation and total rotation both pre-and post-reconstruction. PMID:25568734

Christino, Melissa A.; Vopat, Bryan G.; Waryasz, Gregory R.; Mayer, Alexander; Reinert, Steven E.; Shalvoy, Robert M.

2014-01-01

280

Relationship between static anterior laxity using the KT-1000 and dynamic tibial rotation during motion in patients with anatomical anterior cruciate ligament reconstruction.  

PubMed

The anterior cruciate ligament (ACL) plays an important role in controlling knee joint stability, not only by limiting tibial anterior translation but also by controlling knee axial rotation. The aim of ACL reconstruction is to reduce excessive anterior joint laxity, hoping to restore normal tibiofemoral kinematics including knee axial rotation. The purpose of this study was to investigate the relationship between static anterior instability and tibial rotation during several activities in an anterior cruciate ligament reconstructed knee. Seven patients with unilateral ACL injury performed plain walking, running, landing and side step cutting tasks after ACL reconstruction with a mean follow-up of 14 months. The kinematic data for the 4 motions was measured using a motion analysis system and the point cluster technique. The evaluation period was defined to be from the first contact to removal of the tested leg from the ground. Maximum tibial internal rotation during tasks was calculated using the point cluster technique (PCT). Passive anterior tibial translation was measured using a KT-1000 arthrometer. Regression analysis was used to determine the correlation of the maximum internal rotation with the side-to-side difference of static anterior tibial translation measured using a KT-1000 arthrometer. During side step cutting maneuvers, maximum tibial internal rotation significantly showed negative correlation with static anterior tibial translation (p<0.05, r=0.83). The anterior laxity contributed to the normal knee rotation kinematics. The normal anterior tibial translation obtained by ACL reconstruction is thought to be the key factor in successful restoration of normal knee kinematics. PMID:23925154

Sato, Koji; Maeda, Akira; Takano, Yoshio; Matsuse, Hiroo; Ida, Hirofumi; Shiba, Naoto

2013-01-01

281

[Plastic surgery of the anterior cruciate ligament: experimental study of intra-articular aramid fibers in dogs].  

PubMed

The authors explored the possibility of replacing an anterior cruciate ligament with an aramid fiber (Kevlar) implant. This study was performed in intra-articular site in 9 dogs and the average implantation period was 5 months. Studies were carried out by macroscopic, photon microscopy, and electron microscopy examination of the samples obtained at the time the animals were sacrificed. Clinical and radiographic studies of the knees were performed in order to assess functional consequences. Overall, the results showed a partial or complete rupture of 10 neoligaments out of the 17 studied ligaments; on the other hand, osseous anchorage and reintegration in the intra-articular zone appeared satisfactory. Kevlar fiber only partially meets the performance specifications for an artificial ligament intended to serve as an anterior cruciate ligament substitute. Some positive results have encouraged the authors to carry on further this experimental study. PMID:2595049

Passuti, N; Daculsi, G; Gouin, F; Martin, S; Vigneron, M

1989-01-01

282

Intraoperative comparisons of knee kinematics of double-bundle versus single-bundle anterior cruciate ligament reconstruction  

Microsoft Academic Search

Purpose  Based on biomechanical anatomical studies, double-bundle reconstruction of the anterior cruciate ligament (ACL) was introduced\\u000a to achieve better stability in the knee, particularly in respect of rotatory loads. An in vivo, computer-assisted, double-bundle\\u000a (DB) ACL reconstruction is superior to a single-bundle (SB) ACL reconstruction at reducing rotatory, and AP laxities of the\\u000a tibia at 20 degrees of knee flexion and also

Stephane Plaweski; Mathieu Grimaldi; Aurélien Courvoisier; Simon Wimsey

2011-01-01

283

Use of Electrical Stimulation to Enhance Recovery of Quadriceps Femoris Muscle Force Production in Patients Following Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background and Purpose, Electrical stimulation has been shown to be e$ec- tive in aiding the recovery of quadriceps femoris muscle force production after anterior cruciate ligament reconstruction. The actual dosage of stimulation (training intem'ty) has not been well described. The purpose of this investigation was to establish a dose-response curve for electrical stimulation regimens designed to improve quadriceps femoris muscle

Lynn Snyder-Mackler; Anthony Delitto; Susan W Stralka; Sherri L Bailey

284

Comparison of Rotatory Stability After Anterior Cruciate Ligament Reconstruction Between Single-Bundle and Double-Bundle Techniques  

Microsoft Academic Search

Background: Controversy persists as to whether double-bundle reconstruction of the anterior cruciate ligament (ACL) has any clinical advantage over single-bundle reconstruction. Several studies have used subjective and nonquantitative manual tests to evaluate the rotatory stability of the knee. The authors have developed a method to quantitate the rotatory stability of the ACL-deficient knee using open magnetic resonance imaging (MRI).Hypothesis: Anatomic

Toshiaki Izawa; Ken Okazaki; Yasutaka Tashiro; Hirokazu Matsubara; Hiromasa Miura; Shuichi Matsuda; Makoto Hashizume; Yukihide Iwamoto

2011-01-01

285

Comparison of femoral fixation methods for anterior cruciate ligament reconstruction with patellar tendon graft: a mechanical analysis in porcine knees  

Microsoft Academic Search

The aim of the present study was to evaluate the structural properties of femur–patellar tendon graft complex in anterior\\u000a cruciate ligament (ACL) reconstruction using different femoral fixation devices. Type of study is biomechanical testing. An\\u000a ACL reconstruction was performed on 40 cadaver porcine knees, using patellar tendon (PT) graft. Specimens were divided into\\u000a four groups according to the femoral fixation:

Giuseppe Milano; Pier Damiano Mulas; Fabio Ziranu; Laura Deriu; Carlo Fabbriciani

2007-01-01

286

Mechanical analysis of fixation methods for anterior cruciate ligament reconstruction with hamstring tendon graft. An experimental study in sheep knees  

Microsoft Academic Search

This study evaluates the structural properties of the femur–anterior cruciate ligament (ACL) graft–tibia complex, comparing different graft fixation techniques in sheep knees. Four fixation devices were tested both for femoral fixation (Transfix, absorbable screw, RCI screw and Linx-HT) and tibial fixation (bone plug with metal screw, absorbable screw with staple, RCI screw and cancellous screw with spiked washer). The graft

Carlo Fabbriciani; Pier Damiano Mulas; Fabio Ziranu; Laura Deriu; Donatella Zarelli; Giuseppe Milano

2005-01-01

287

Activity Level and Graft Type as Risk Factors for Anterior Cruciate Ligament Graft FailureA Case-Control Study  

Microsoft Academic Search

Background: Anterior cruciate ligament (ACL) graft failure is an uncommon but devastating event after reconstruction, and risk factors for graft failure are not well understood.Hypothesis: Returning to a high activity level after ACL reconstruction and use of an allograft are risk factors for ACL graft failure.Study Design: Case-control study; Level of evidence, 3.Methods: Twenty-one patients with ACL graft failure were

James R. Borchers; Angela Pedroza; Christopher Kaeding

2009-01-01

288

Anterior Cruciate Ligament Injury in National Collegiate Athletic Association Basketball and SoccerA 13Year Review  

Microsoft Academic Search

Background: Female collegiate athletes have been reported to have a higher rate of anterior cruciate ligament injury compared to male collegiate athletes. This finding has spawned a branch of research focused on understanding and preventing this injury pattern.Purpose: To determine if the trends reported in 1994 have continuedStudy Type: Descriptive epidemiology studyMethods: The National Collegiate Athletic Association Injury Surveillance System

Julie Agel; Elizabeth A. Arendt; Boris Bershadsky

2005-01-01

289

Post-operative analgesia following anterior cruciate ligament reconstruction: a controlled study using femoral nerve regional anaesthesia  

Microsoft Academic Search

We present a prospective randomised double-blind study assessing the value of femoral nerve block anaesthesia (FNB) in patients undergoing anterior cruciate ligament reconstruction. Patients in the study group received a FNB using a nerve stimulator to deliver 20 ml of 0.5% marcaine together with a patient-controlled analgesia system delivering morphine. Patients in the control group received only a patient-controlled analgesia

N. J. Harris; D. R. Bickerstaff; D. Farquharson; F. J. Appleton

1997-01-01

290

Anterior cruciate ligament (ACL)-deficient knee with degenerative arthrosis: treatment with an isolated autogenous patellar tendon ACL reconstruction  

Microsoft Academic Search

We evaluated 58 patients (mean age 30.4 years) who had undergone an isolated anterior cruciate ligament (ACL) reconstruction\\u000a for chronic instability (mean time from injury to surgery, 8.2 ± 5.2 years) and showed radiographic evidence of degenerative\\u000a arthrosis. Objective evaluation at a mean of 4.1 years postoperatively included KT-1000 arthrometer stability, range of motion,\\u000a and quadriceps muscle strength testing. Subjective

K. D. Shelbourne; Keith C. Stube

1997-01-01

291

Jump Landing Strategies in Male and Female College Athletes and the Implications of Such Strategies for Anterior Cruciate Ligament Injury  

Microsoft Academic Search

Background: Female athletes are more likely than male athletes to injure the anterior cruciate ligament. Causes of this increased injury incidence in female athletes remain unclear, despite numerous investigations.Hypothesis: Female athletes will exhibit lower hamstring muscle activation and smaller knee flexion angles than male athletes during jump landings, especially when the knee muscles are fatigued.Study Design: Controlled laboratory study.Methods: Eight

Ray Fagenbaum; Warren G. Darling

2003-01-01

292

Morphologic Characteristics Help Explain the Gender Difference in Peak Anterior Cruciate Ligament Strain During a Simulated Pivot Landing  

Microsoft Academic Search

Background: Gender differences exist in anterior cruciate ligament (ACL) cross-sectional area and lateral tibial slope. Biomechanical principles suggest that the direction of these gender differences should induce larger peak ACL strains in females under dynamic loading.Hypothesis: Peak ACL relative strain during a simulated pivot landing is significantly greater in female ACLs than male ACLs.Study Design: Controlled laboratory study.Methods: Twenty cadaveric

David B. Lipps; Youkeun K. Oh; James A. Ashton-Miller; Edward M. Wojtys

2012-01-01

293

Good results five years after surgical management of anterior cruciate ligament tears, and meniscal and cartilage injuries  

Microsoft Academic Search

In athletes with anterior cruciate ligament (ACL) tears combined with meniscal and cartilage injuries, the goals are to restore\\u000a knee laxity and relieve symptoms, while long-term goals are the return to pre-injury sport activity and to prevent onset of\\u000a degenerative changes. We compared the post-operative (minimum 5 years) clinical and radiological outcomes of 50 patients,\\u000a similar for ACL rupture and meniscal

Leonardo OstiRocco; Rocco Papalia; Angelo Del Buono; Cirino Amato; Vincenzo Denaro; Nicola Maffulli

2010-01-01

294

Osteointegration of soft tissue grafts within the bone tunnels in anterior cruciate ligament reconstruction can be enhanced  

Microsoft Academic Search

Anterior cruciate ligament reconstruction with a soft tissue autograft (hamstring autograft) has grown in popularity in the\\u000a last 10 years. However, the issues of a relatively long healing time and an inferior histological healing result in terms\\u000a of Sharpey-like fibers connection in soft tissue grafts are still unsolved. To obtain a promising outcome in the long run,\\u000a prompt osteointegration of the

Guan-Ming Kuang; W. P. Yau; William W. Lu; K. Y. Chiu

2010-01-01

295

Arthroscopically assisted meniscal allograft transplantation with and without combined anterior cruciate ligament reconstruction  

Microsoft Academic Search

The menisci provide a vital role in load transmission across the knee joint as well as contribute to knee stability, particularly in the ACL-deficient knee. Loss of the meniscus, in part or in total, significantly alters joint function and predisposes the articular cartilage to degenerative changes, which has been well documented both clinically and radiographically. This study examined clinical and

Erol A. Yoldas; Jon K. Sekiya; James J. Irrgang; Freddie H. Fu; Christopher D. Harner

2003-01-01

296

Early knee motion after open and arthroscopic anterior cruciate ligament reconstruction  

Microsoft Academic Search

The hypothesis proposed in this study was that the initiation of active and passive knee motion within 48 hours of major intraarticular knee ligament surgery would not have the deleterious effects of increasing knee effusion, hemarthrosis, periarticular soft tissue edema, and swelling.We conducted a prospective study with randomized assignment of 18 patients into two groups: 9 patients in the \\

Frank R. Noyes; Robert E. Mangine; Sue Barber

1987-01-01

297

Serial assessments to determine normalization of gait following anterior cruciate ligament reconstruction.  

PubMed

There is an increased emphasis to identify clinically applicable methods that quantify gait deficits following anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to perform serial gait assessments in a clinical setting to determine whether and when clinical gait parameters normalize in patients following ACLR. The hypothesis was that a clinically available gait treadmill would quantify gait deficits measured at 4 weeks post-reconstruction. The secondary hypothesis was that patients would demonstrate incremental improvements in these gait parameters measured at each interval up to 12 weeks post-reconstruction, and that the objectively measured improvements would correlate to the patient's subjective rating of function. Fifteen subjects, five male and 10 female, who had initial unilateral anterior cruciate ligament injury were selected for this study on the basis of operative data. All subjects were evaluated in a physical therapy clinic within 3 days following ACLR and were enrolled in a standardized rehabilitation program. The dependent gait variables of step length, stance time and gait velocity were measured at 4, 6, 8 and 12 weeks post-ACLR on a commercially available gait treadmill. A 2 x 4 multivariate analysis of variance (2 within factors) with measures for limb involvement (uninvolved and involved) and repeated measures for time (4, 6, 8 and 12 weeks) was used to assess the interactions and the main effects on the gait variables of stance time and step length. The results of this study supported the hypothesis that gait deficits and serial improvements can be objectively quantified in a clinical setting (P<0.001). Specifically, stance time, step length and gait velocity deficits evaluated at 4 weeks showed significant improvements at the measured intervals. Step length normalized at week 8. Stance time and gait velocity reached normal levels at the 12-week time interval. Subjective activity of daily living scores (ADLS) also improved following the 12-week rehabilitation, from 53+/-17% to a mean score of 88+/-11% (P<0.001). ADLS scores significantly correlated to step length (R=0.63) and stance time (R=0.53) in the involved limb. Self-selected gait velocity also correlated to ADLS scores and significantly predicted 49% of the variance in the subjective outcome measure. A clinically available gait treadmill can be used to quantify gait deficits and improvements following ACLR. Serial assessments of walking gait may aid clinicians to identify and target deficits in their patients during rehabilitation. PMID:18510594

Minning, S J; Myer, G D; Mangine, R E; Eifert-Mangine, M; Colosimo, A J

2009-08-01

298

Evaluation of Kinematics of Anterior Cruciate Ligament-Deficient Knees with Use of Advanced Imaging Techniques, Three-Dimensional Modeling Techniques, and Robotics  

PubMed Central

Measuring knee biomechanics in six degrees of freedom with acceptable accuracy has been proven to be technically challenging. At our bioengineering laboratory, we have employed both an in vitro robotic testing system and an in vivo combined dual fluoroscopic and magnetic resonance imaging technique to analyze the impact of anterior cruciate ligament rupture on the knee joint. When measuring the tibiofemoral kinematics of nine cadavers with the robotic testing system, we found that anterior cruciate ligament deficiency not only altered anterior translation and axial rotation of the tibia, but it also increased the medial translation of the tibia as well. The in vivo dual fluoroscopic imaging analysis of tibiofemoral kinematics in ten anterior cruciate ligament-deficient patients revealed analogous findings: an increased medial translation of the tibia of approximately 1 mm between 15° and 90° of flexion was found in anterior cruciate ligament-deficient knees, in addition to an increased anterior translation (approximately 3 mm) and internal rotation (approximately 2°) of the tibia at low flexion angles. In a subsequent study of tibiofemoral cartilage contact, we found that the cartilage contact points shifted posteriorly—as was expected on the basis of the increased anterior tibial translation—as well as laterally on the surface of the tibial plateau. The data demonstrate how rupture of the anterior cruciate ligament initiates a cascade of events that eventually results in abnormal tibiofemoral cartilage contact in both the anteroposterior and mediolateral directions. If the restoration of normal knee homeostasis is the ultimate goal of ligament reconstruction, the normal function of the anterior cruciate ligament should be restored as closely as possible in all degrees of freedom. PMID:19182035

Van de Velde, Samuel K.; Gill, Thomas J.; Li, Guoan

2009-01-01

299

In vitro study on silk fibroin textile structure for anterior cruciate ligament regeneration.  

PubMed

A novel hierarchical textile structure made of silk fibroin from Bombyx mori capable of matching the mechanical performance requirements of anterior cruciate ligament (ACL) and in vitro cell ingrowth is described. This sericin-free, Silk Fibroin Knitted Sheath with Braided Core (SF-KSBC) structure was fabricated using available textile technologies. Micro-CT analysis confirmed that the core was highly porous and had a higher degree of interconnectivity than that observed for the sheath. The in vivo cell colonization of the scaffolds is thus expected to penetrate even the internal parts of the structure. Tensile mechanical tests demonstrated a maximum load of 1212.4±56.4 N (under hydrated conditions), confirming the scaffold's suitability for ACL reconstruction. The absence of cytotoxic substances in the extracts of the SF-KSBC structure in culture medium was verified by in vitro tests with L929 fibroblasts. In terms of extracellular matrix production, Human Periodontal Ligament Fibroblasts (HPdLFs) cultured in direct contact with SF-KSBC, compared to control samples, demonstrated an increased secretion of aggrecan (PG) and fibronectin (FBN) at 3 and 7 days of culture, and no change in IL-6 and TNF-? secretion. Altogether, the outcomes of this investigation confirm the significant utility of this novel scaffold for ACL tissue regeneration. PMID:23910255

Farè, Silvia; Torricelli, Paola; Giavaresi, Gianluca; Bertoldi, Serena; Alessandrino, Antonio; Villa, Tomaso; Fini, Milena; Tanzi, Maria Cristina; Freddi, Giuliano

2013-10-01

300

Inertial sensors to quantify the pivot shift test in the treatment of anterior cruciate ligament injury  

PubMed Central

The main purpose of this article was to describe in detail, from the perspective of the clinical end user, a previously presented non-invasive methodology, applied in the treatment of anterior cruciate ligament injury, in which inertial sensors are used to quantify the pivot shift test. The outcomes obtained and relative considerations were compared with findings emerging from a review of the relevant updated literature. The detailed description here provided covers the system, the parameters identified and the testing procedure; it also includes the technical specifications of the hardware, the features introduced in the updated version of the software and the application of the system in clinical practice. The comparison of the technical considerations and clinical results with the updated literature confirmed the system’s optimal ergonomics, good reproducibility and clinical reliability. The novel approach here analyzed has been shown to overcome the weaknesses of other available devices and systems. Therefore, since it can be considered a new paradigm in the quantification of pivot shift test, we can recommend its routine use in clinical practice. PMID:25606555

ZAFFAGNINI, STEFANO; LOPOMO, NICOLA; SIGNORELLI, CECILIA; MUCCIOLI, GIULIO MARIA MARCHEGGIANI; BONANZINGA, TOMMASO; GRASSI, ALBERTO; RAGGI, FEDERICO; VISANI, ANDREA; MARCACCI, MAURILIO

2014-01-01

301

Stereoscopic filming for investigating evasive side-stepping and anterior cruciate ligament injury risk  

NASA Astrophysics Data System (ADS)

Non-contact anterior cruciate ligament (ACL) injuries are serious and debilitating, often resulting from the performance of evasive sides-stepping (Ssg) by team sport athletes. Previous laboratory based investigations of evasive Ssg have used generic visual stimuli to simulate realistic time and space constraints that athletes experience in the preparation and execution of the manoeuvre. However, the use of unrealistic visual stimuli to impose these constraints may not be accurately identifying the relationship between the perceptual demands and ACL loading during Ssg in actual game environments. We propose that stereoscopically filmed footage featuring sport specific opposing defender/s simulating a tackle on the viewer, when used as visual stimuli, could improve the ecological validity of laboratory based investigations of evasive Ssg. Due to the need for precision and not just the experience of viewing depth in these scenarios, a rigorous filming process built on key geometric considerations and equipment development to enable a separation of 6.5 cm between two commodity cameras had to be undertaken. Within safety limits, this could be an invaluable tool in enabling more accurate investigations of the associations between evasive Ssg and ACL injury risk.

Lee, Marcus J. C.; Bourke, Paul; Alderson, Jacqueline A.; Lloyd, David G.; Lay, Brendan

2010-02-01

302

Glucosamine Supplementation after Anterior Cruciate Ligament Reconstruction in Athletes: A Randomized Placebo-controlled Trial.  

PubMed

Although glucosamine is commonly consumed by athletes, its effectiveness in sports injuries is still under debate. We aimed to investigate the effects of glucosamine to the rehabilitation outcomes of anterior cruciate ligament (ACL) reconstructed athletes. Glucosamine-sulfate (1000 mg daily, for 8 weeks) was administered to half of the cohort of 30 male athletes, the other half used a placebo. Both groups received the same rehabilitation protocol. Knee pain and functions were evaluated by a visual analogue scale (VAS), International Knee Documentation Committee (IKDC) and Lysholm scores before and after oral administration. Additionally, an isokinetic test was performed after the administration period. The scores revealed significant improvements in both groups after 8 weeks, but no significant difference was detected between groups in any of the parameters. Glucosamine supplementation did not improve the rehabilitation outcomes of athletes after ACL reconstruction. This is the first study investigating this topic. Further studies will help to obtain clear evidence about glucosamine efficacy on ACL injured or ACL reconstructed athletes. PMID:25630243

Eraslan, Ali; Ulkar, Bulent

2015-01-01

303

The Effects of Rehabilitation Protocol on Functional Recovery After Anterior Cruciate Ligament Reconstruction  

PubMed Central

ABSTRACT Introduction: The use of rehabilitation protocol which corresponds to surgical technique results in optimal postoperative outcome and functional recovery of patients to a pre-injury level of activity. The aim of this paper is to show the effects of the official rehabilitation protocol in our Institute on functional recovery of patients after anterior cruciate ligament (ACL) reconstruction. Patients and methods: In prospective study, we evaluated 70 males after ACL reconstruction using hamstring graft. Patients were divided into two groups according to the manner of conducting the postoperative rehabilitation. Group A consisted of 35 patients that followed postoperative rehabilitation according to the rehabilitation protocol. Group B also 35 patients, which did not undergo the rehabilitation protocol. We evaluated thigh muscle circumference and modified Tegner Lysholm Score, preoperatively and postoperatively after 1,3,6 and 12 months. In the statistical analysis, the Studentov T-test was used. Results: In the first postoperative month, the difference between groups in thigh muscle circumference is statistically significant (p<0,05). This difference between groups is statistically highly significant after 3, 6, and 12 months postoperative (p<0,01). Results of the modified Tegner Lysholm Score is statistically highly significant in 1, 3 and 6 postoperative months in patients from the experimental group (p<0,01). Conclusion: The positive effects of the rehabilitation protocol results in significant increase of the thigh muscle circumference and faster functional recovery of patients after ACL reconstruction. PMID:25568570

Dragicevic-Cvjetkovic, Dragana; Jandric, Slavica; Bijeljac, Sinisa; Palija, Stanislav; Manojlovic, Slavko; Talic, Goran

2014-01-01

304

Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction.  

PubMed

[Purpose] To compare outcomes of anterior cruciate ligament (ACL) reconstruction after open kinetic chain (OKC) exercises and closed kinetic chain (CKC) exercises. [Subjects and Methods] The subjects comprised 11 female and 47 male patients who are randomly divided into two groups: which performed a CKC exercise program Group I and Group II which performed an OKC exercise program. Pain intensity was evaluated using visual analogue scale (VAS). Knee flexion was evaluated using a universal goniometer, and thigh circumference measurements were taken with a tape measure at baseline and at 3 months and 6 months after the treatment. Lysholm scores were used to assess knee function. [Results] There were no significant differences between the two groups at baseline. Within each group, VAS values and knee flexion were improved after the surgery. These improvements were significantly higher in the CKC group than in the OKC group. There were increases in thigh circumference difference at the 3 and 6 month assessments post-surgery. A greater improvement in the Lysholm score was observed in the CKC group at 6 months. [Conclusion] The CKC exercise program was more effective than OKC in improving the knee functions of patients with ACL reconstruction. PMID:25540486

Uçar, Mehmet; Koca, Irfan; Eroglu, Mehmet; Eroglu, Selma; Sarp, Umit; Arik, Hasan Onur; Yetisgin, Alparslan

2014-12-01

305

Muscle activity amplitudes and co-contraction during stair ambulation following anterior cruciate ligament reconstruction.  

PubMed

The purpose of this study was to compare muscle activity amplitudes and co-contraction in those with anterior cruciate ligament (ACL) reconstruction to healthy controls during stair negotiation. Eighteen participants with unilateral ACL reconstruction and 17 healthy controls performed stair ascent and descent while surface electromyography was recorded from knee and hip musculature. During stair ascent, the ACL group displayed higher gluteus maximus activity (1-50% stance, p=0.02), higher vastus lateralis:biceps femoris co-contraction (51-100% stance, p=0.01), and higher vastus lateralis:vastus medialis co-contraction (51-100% stance, p=0.05). During stair descent, the ACL group demonstrated higher gluteus maximus activity (1-50% stance, p=0.01; 51-100% stance, p<0.01), lower rectus femoris activity (1-50% stance, p=0.04), higher semimembranosus activity (1-50% stance, p=0.01), higher gluteus medius activity (51-100% stance, p=0.01), and higher vastus medialis:semimembranosus co-contraction (1-50% stance, p=0.02). While the altered muscle activity strategies observed in the ACL group may act to increase joint stability, these strategies may alter joint loading and contribute to post-traumatic knee osteoarthritis often observed in this population. Our results warrant further investigation to determine the longterm effects of altered muscle activity on the knee joint following ACL reconstruction. PMID:25716325

Hall, Michelle; Stevermer, Catherine A; Gillette, Jason C

2015-04-01

306

An Ambulatory Method of Identifying Anterior Cruciate Ligament Reconstructed Gait Patterns  

PubMed Central

The use of inertial sensors to characterize pathological gait has traditionally been based on the calculation of temporal and spatial gait variables from inertial sensor data. This approach has proved successful in the identification of gait deviations in populations where substantial differences from normal gait patterns exist; such as in Parkinsonian gait. However, it is not currently clear if this approach could identify more subtle gait deviations, such as those associated with musculoskeletal injury. This study investigates whether additional analysis of inertial sensor data, based on quantification of gyroscope features of interest, would provide further discriminant capability in this regard. The tested cohort consisted of a group of anterior cruciate ligament reconstructed (ACL-R) females and a group of non-injured female controls, each performed ten walking trials. Gait performance was measured simultaneously using inertial sensors and an optoelectronic marker based system. The ACL-R group displayed kinematic and kinetic deviations from the control group, but no temporal or spatial deviations. This study demonstrates that quantification of gyroscope features can successfully identify changes associated with ACL-R gait, which was not possible using spatial or temporal variables. This finding may also have a role in other clinical applications where small gait deviations exist. PMID:24451464

Patterson, Matthew R.; Delahunt, Eamonn; Sweeney, Kevin T.; Caulfield, Brian

2014-01-01

307

Current practice variations in the management of anterior cruciate ligament injuries in Croatia  

PubMed Central

AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament (ACL) injury in Croatia. METHODS: The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire. RESULTS: Thirty nine surgeons responded to the survey. Nearly all participants (95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach (67% vs 33%). Suspensory fixation was the most common graft fixation method (62%) for the femoral side, followed by the cross-pin (33%) and bioabsorbable interference screw (5%). Almost all respondents (97%) used a bioabsorbable interference screw for tibial side graft fixation. CONCLUSION: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature. PMID:24147268

Mahnik, Alan; Mahnik, Silvija; Dimnjakovic, Damjan; Curic, Stjepan; Smoljanovic, Tomislav; Bojanic, Ivan

2013-01-01

308

Reconstruction of the anterior cruciate ligament: association of graft choice with increased risk of early revision.  

PubMed

We examined the association of graft type with the risk of early revision of primary anterior cruciate ligament reconstruction (ACLR) in a community-based sample. A retrospective analysis of a cohort of 9817 ACLRs recorded in an ACLR Registry was performed. Patients were included if they underwent primary ACLR with bone-patellar tendon-bone autograft, hamstring tendon autograft or allograft tissue. Aseptic failure was the main endpoint of the study. After adjusting for age, gender, ethnicity, and body mass index, allografts had a 3.02 times (95% confidence interval (CI) 1.93 to 4.72) higher risk of aseptic revision than bone-patellar tendon-bone autografts (p < 0.001). Hamstring tendon autografts had a 1.82 times (95% CI 1.10 to 3.00) higher risk of revision compared with bone-patellar tendon-bone autografts (p = 0.019). For each year increase in age, the risk of revision decreased by 7% (95% CI 5 to 9). In gender-specific analyses a 2.26 times (95% CI 1.15 to 4.44) increased risk of hamstring tendon autograft revision in females was observed compared with bone-patellar tendon-bone autograft. We conclude that allograft tissue, hamstring tendon autografts, and younger age may all increase the risk of early revision surgery after ACLR. PMID:23632671

Maletis, G B; Inacio, M C S; Desmond, J L; Funahashi, T T

2013-05-01

309

Mechanical evaluation of a soft tissue interference screw in free tendon anterior cruciate ligament graft fixation.  

PubMed

In this study of bioabsorbable screw fixation of free tendon grafts used in anterior cruciate ligament reconstruction, we performed load-to-failure and cyclic loading of tendon fixation in porcine bone. Bone density measurements from dual photon absorptometry scans were obtained to correlate bone density with fixation failure. The average density of porcine bone (1.42 g/cm2) was similar to that of young human bone (1.30 g/cm2) and significantly higher than that of elderly human cadaveric bone specimens (0.30 g/cm2). Cyclic loading was performed on free tendon grafts fixed with a bioabsorbable screw alone and on grafts fixed with a bioabsorbable screw and an anchor (polylactic acid ball or cortical bone disk). Stiffness of fixation increased substantially with the addition of a cortical bone disk anchor or polylactic acid ball compared with the interference screw alone. Tensile fixation strength of central quadriceps free tendon and hamstring tendon grafts were significantly superior in porcine bone of density similar to young human bone than in elderly human cadaveric bone. The bioabsorbable interference screw yielded loads at failure comparable with traditional bone-tendon-bone and hamstring tendon fixation when controlled for bone density. The addition of a cortical bone disk anchor provided the most optimal fixation of free tendon with the bioabsorbable screw and reduced slippage with cyclic loading to a very low level. PMID:11206259

Nagarkatti, D G; McKeon, B P; Donahue, B S; Fulkerson, J P

2001-01-01

310

Review of evolution of tunnel position in anterior cruciate ligament reconstruction  

PubMed Central

Anterior cruciate ligament (ACL) rupture is one of the commonest knee sport injuries. The annual incidence of the ACL injury is between 100000-200000 in the United States. Worldwide around 400000 ACL reconstructions are performed in a year. The goal of ACL reconstruction is to restore the normal knee anatomy and kinesiology. The tibial and femoral tunnel placements are of primordial importance in achieving this outcome. Other factors that influence successful reconstruction are types of grafts, surgical techniques and rehabilitation programmes. A comprehensive understanding of ACL anatomy has led to the development of newer techniques supplemented by more robust biological and mechanical concepts. In this review we are mainly focussing on the evolution of tunnel placement in ACL reconstruction, focusing on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched. Definite clinical and functional data is lacking to establish the superiority of the single or double bundle reconstruction technique. While there is a trend towards the use of anteromedial portals for femoral tunnel placement, their clinical superiority over trans-tibial tunnels is yet to be established. PMID:25793165

Rayan, Faizal; Nanjayan, Shashi Kumar; Quah, Conal; Ramoutar, Darryl; Konan, Sujith; Haddad, Fares S

2015-01-01

311

Evaluation of manual test for anterior cruciate ligament injury using a body-mounted sensor  

NASA Astrophysics Data System (ADS)

Diagnosis method of anterior cruciate ligament (ACL) using body-mounted sensor is discussed. A wide variety of diagnosis method such as Pivot Shift Test (PST), Lachman Test and monitoring of jump motion (JT) are applied to examine the injured ACL. These methods, however, depend on the ability and the experience of examiner. The proposed method numerically provides three dimensional translation and rotation of the knee by using a newly developed 3D sensor. The 3D sensor is composed of three accelerometers and three gyroscopes. Measured acceleration of the knee during the examination is converted to the fixed system of coordinate according the acceleration of gravity and 3D rotation of the sensor, and is numerically integrated to derive 3D trajectory and rotation angle around the tibia. The experimental results of JT suggest that unsymmetrical movement of rotation angle of the tibia and sudden movement of estimated 3D trajectory show instability of knee joint. From the results of PST analysis, it is observed that the tibial angular velocity around the flexed position changes 41.6 [deg/s] at the injured side and 21.7 [deg/s] at the intact side. This result suggests the reposition of injured knee from subluxation.

Yoshida, R.; Sagawa, K.; Tsukamoto, T.; Ishibashi, Y.

2007-12-01

312

Evaluation of Open and Closed Kinetic Chain Exercises in Rehabilitation Following Anterior Cruciate Ligament Reconstruction  

PubMed Central

[Purpose] To compare outcomes of anterior cruciate ligament (ACL) reconstruction after open kinetic chain (OKC) exercises and closed kinetic chain (CKC) exercises. [Subjects and Methods] The subjects comprised 11 female and 47 male patients who are randomly divided into two groups: which performed a CKC exercise program Group I and Group II which performed an OKC exercise program. Pain intensity was evaluated using visual analogue scale (VAS). Knee flexion was evaluated using a universal goniometer, and thigh circumference measurements were taken with a tape measure at baseline and at 3 months and 6 months after the treatment. Lysholm scores were used to assess knee function. [Results] There were no significant differences between the two groups at baseline. Within each group, VAS values and knee flexion were improved after the surgery. These improvements were significantly higher in the CKC group than in the OKC group. There were increases in thigh circumference difference at the 3 and 6 month assessments post-surgery. A greater improvement in the Lysholm score was observed in the CKC group at 6 months. [Conclusion] The CKC exercise program was more effective than OKC in improving the knee functions of patients with ACL reconstruction. PMID:25540486

Uçar, Mehmet; Koca, Irfan; Eroglu, Mehmet; Eroglu, Selma; Sarp, Umit; Arik, Hasan Onur; Yetisgin, Alparslan

2014-01-01

313

Joint infection unique to hamstring tendon harvester used during anterior cruciate ligament reconstruction surgery.  

PubMed

Joint infection after anterior cruciate ligament (ACL) reconstruction is a rare but important clinical issue that must be resolved quickly to prevent secondary joint damage and preserve the graft. After careful analysis, we observed 3 infection cases within a 12-month period after ACL reconstruction, which represented an abnormally elevated risk. All reconstructions were performed by the same surgeon and used hamstring tendon allograft. For each surgery, the Target Tendon Harvester (DePuy Mitek, Raynham, MA) was used to harvest hamstring tendons. Through our review, we learned that this instrument was sterilized while assembled. It is our belief that ineffective sterilization of this hamstring graft harvester served as the origin for these infections. We have determined that appropriate sterilization technique involves disassembly of this particular hamstring tendon harvester before sterilization because of the tube-within-a-tube configuration. We have since continued to use the Target Tendon Harvester, disassembling it before sterilization. There have been no infections in the ensuing 12 months during which the surgeon performed over 40 primary ACL reconstructions via hamstring autograft. The information from this report is intended to provide arthroscopists with information about potential sources of infection after ACL reconstruction surgery. PMID:18442698

Tuman, Jeffrey; Diduch, David R; Baumfeld, Joshua A; Rubino, L Joseph; Hart, Joseph M

2008-05-01

314

Growth Factors and Stem Cells for the Management of Anterior Cruciate Ligament Tears  

PubMed Central

The anterior cruciate ligament (ACL) is fundamental for the knee joint stability. ACL tears are frequent, especially during sport activities, occurring mainly in young and active patients. Nowadays, the gold standard for the management of ACL tears remains the surgical reconstruction with autografts or allografts. New strategies are being developed to resolve the problems of ligament grafting and promote a physiological healing process of ligamentous tissue without requiring surgical reconstruction. Moreover, these strategies can be applicable in association surgical reconstruction and may be useful to promote and accelerate the healing process. The use of growth factors and stem cells seems to offer a new and fascinating solution for the management of ACL tears. The injection of stem cell and/or growth factors in the site of ligamentous injury can potentially enhance the repair process of the physiological tissue. These procedures are still at their infancy, and more in vivo and in vitro studies are required to clarify the molecular pathways and effectiveness of growth factors and stem cells therapy for the management of ACL tears. This review aims to summarize the current knowledge in the field of growth factors and stem cells for the management of ACL tears. PMID:23248722

Rizzello, Giacomo; Longo, Umile Giuseppe; Petrillo, Stefano; Lamberti, Alfredo; Khan, Wasim Sardar; Maffulli, Nicola; Denaro, Vincenzo

2012-01-01

315

Pre-operative planning in anterior cruciate ligament reconstruction revision surgery  

PubMed Central

Summary Primary reconstructions of the anterior cruciate ligament are common and increasing in number, a trend inevitably paralleled by an increase in the number of revision procedures. Failure of primary ACL reconstruction can appear as objective residual laxity, subjective instability, severe and persistent postoperative stiffness and/or pain, or infection. Revision surgery is a complex procedure, in which the expected clinical outcome is inferior to that which can be expected from primary reconstruction, and patients have a 5.4% risk of undergoing a second revision after five years. This type of procedure demands correct and exhaustive preoperative planning so as ensure optimal treatment of accompanying lesions and of any complications arising during surgery. It is important to know, in detail, the patient’s clinical history (when the primary surgery was performed and the technique used, the cause of the recurrence, the degree of functional recovery, etc.), to perform a thorough clinical examination (to evaluate alignment, gait cycle, skin color, the trophic condition of the muscles, joint laxity), and to have available the results of a detailed and specific imaging study and also of blood tests, in order to exclude the presence of an infection. PMID:25606508

Adriani, Ezio; Summa, Pierpaolo; Di Paola, Berardino

2013-01-01

316

Prevention of anterior cruciate ligament injuries in soccer. A prospective controlled study of proprioceptive training.  

PubMed

Proprioceptive training has been shown to reduce the incidence of ankle sprains in different sports. It can also improve rehabilitation after anterior cruciate ligament (ACL) injuries whether treated operatively or nonoperatively. Since ACL injuries lead to long absence from sports and are one of the main causes of permanent sports disability, it is essential to try to prevent them. In a prospective controlled study of 600 soccer players in 40 semiprofessional or amateur teams, we studied the possible preventive effect of a gradually increasing proprioceptive training on four different types of wobble-boards during three soccer seasons. Three hundred players were instructed to train 20 min per day with 5 different phases of increasing difficulty. The first phase consisted of balance training without any balance board; phase 2 of training on a rectangular balance board; phase 3 of training on a round board; phase 4 of training on a combined round and rectangular board; phase 5 of training on a so-called BABS board. A control group of 300 players from other, comparable teams trained "normally" and received no special balance training. Both groups were observed for three whole soccer seasons, and possible ACL lesions were diagnosed by clinical examination, KT-1000 measurements, magnetic resonance imaging or computed tomography, and arthroscopy. We found an incidence of 1.15 ACL injuries per team per year in the proprioceptively trained group (P < 0.001). Proprioceptive training can thus significantly reduce the incidence of ACL injuries in soccer players. PMID:8963746

Caraffa, A; Cerulli, G; Projetti, M; Aisa, G; Rizzo, A

1996-01-01

317

Effect of anterior cruciate healing on the uninjured ligament insertion site.  

PubMed

The effect of anterior cruciate healing on the uninjured ligament insertion site after enhanced suture repair with collagen-platelet composites (CPC) has not yet been defined. In this study, we hypothesized that fibroblasts and osteoclasts would participate in generating histologic changes in insertion site morphology after transection and bioenhanced repair of the ACL, and that these changes would be age-dependent. Skeletally immature, adolescent, and adult Yucatan mini-pigs underwent ACL transection and bioenhanced suture repair. The histologic response to repair of the insertion site was evaluated at 1, 2, 4, and 15 weeks. In young and adolescent animals treated with bioenhanced suture repair with CPC, changes in the insertion site included: (1) fibroblastic proliferation with loss and return of collagen alignment in the fibrous zone; (2) osteoclastic resorption within fibrocartilage zones at 2-4 weeks; and (3) partial reappearance of fibrocartilage zones at 15 weeks. In adult animals; however, degenerative changes were noted by 15 weeks: (1) loss of parallel arrangement of collagen fibers in the fibrous zone; and (2) increasing disorganization and loss of columnation of chondrocytes in the fibrocartilage zone. These results suggest that fibroblasts and osteoclasts mediate histologic changes at the insertion site during bioenhanced suture repair of the ACL which may prevent insertion site degeneration, and that the magnitude of these changes may be a function of skeletal maturity. PMID:21748793

Haus, Brian M; Mastrangelo, Ashley N; Murray, Martha M

2012-01-01

318

Rationale and Clinical Techniques for Anterior Cruciate Ligament Injury Prevention Among Female Athletes  

PubMed Central

Objective: To present the rationale and detailed techniques for the application of exercises targeted to prevent anterior cruciate ligament (ACL) injury in high-risk female athletes. Background: Female athletes have a 4- to 6-fold increased risk for ACL injury compared with their male counterparts playing at similar levels in the same sports. The increased ACL injury risk coupled with greater sports participation by young women over the last 30 years (9-fold increase in high school and 5-fold increase in collegiate sports) has generated public awareness and fueled several sex-related mechanistic and interventional investigations. These investigations provide the groundwork for the development of neuromuscular training aimed at targeting identified neuromuscular imbalances to decrease ACL injury risk. Description: After the onset of puberty, female athletes may not have a neuromuscular spurt to match their similar, rapid increase in growth and development. The lack of a natural neuromuscular adaptation may facilitate the development of neuromuscular imbalances that increase the risk for ACL injury. Dynamic neuromuscular analysis training provides the methodologic approach for identifying high-risk individuals and the basis of using interventions targeted to their specific needs. Clinical Advantages: Dynamic neuromuscular training applied to the high-risk population may decrease ACL injury risk and help more female athletes enjoy the benefits of sports participation without the long-term disabilities associated with injury. PMID:15592608

Myer, Gregory D; Ford, Kevin R; Hewett, Timothy E

2004-01-01

319

A biodegradable tri-component graft for anterior cruciate ligament reconstruction.  

PubMed

Bone-patellar tendon-bone (BPTB) autografts are the gold standard for anterior cruciate ligament (ACL) reconstruction because the bony ends allow for superior healing and anchoring through bone-to-bone regeneration. However, the disadvantages of BPTB grafts include donor site morbidity and patellar rupture. In order to incorporate bone-to-bone healing without the risks associated with harvesting autogenous tissue, a biodegradable and synthetic tri-component graft was fabricated, consisting of porous poly(1,8-octanediol-co-citric acid)-hydroxyapatite nanocomposites (POC-HA) and poly(l-lactide) (PLL) braids. All regions of the tri-component graft were porous and the tensile properties were in the range of the native ACL. When these novel grafts were used to reconstruct the ACL of rabbits, all animals after 6?weeks were weight-bearing and showed good functionality. Histological assessment confirmed tissue infiltration throughout the entire scaffold and tissue ingrowth and interlocking within the bone tunnels, which is favourable for graft fixation. In conclusion, this pilot study suggests that a tri-component, biodegradable graft is a promising strategy to regenerate tissue types necessary for ACL tissue engineering, and provides a basis for developing an off-the-shelf graft for ACL repair. Copyright © 2014 John Wiley & Sons, Ltd. PMID:25414080

Chung, Eun Ji; Sugimoto, Matthew J; Koh, Jason L; Ameer, Guillermo A

2014-11-21

320

Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: basketball.  

PubMed

The purpose of this paper is to outline the final, functional phases of rehabilitation that address exercises, drills, and return-to-play criteria for the sport of basketball, following anterior cruciate ligament (ACL) reconstruction. ACL injuries can be debilitating and affect the quality of life for recreational and elite athletes alike. Tears of the ACL are common in both male and female basketball players, with a higher incidence rate in females. Incidence of a retear to the existing graft or contralateral knee within 5 years of ACL reconstruction with patellar tendon autograft in young (less than 18 to 25 years of age), active basketball players can be as high as 52%. Reducing the number of ACL injuries or reinjury, of which there are an estimated 80 000 per year at an associated cost of over a billion dollars, can have significant potential long-term fiscal and health benefits. Following surgical reconstruction of the ACL, implementing a tailored rehabilitation protocol can ensure a successful return to sport. When searching the literature for such protocols, clinicians may struggle to find specific exercises, drills, and return-to-play criteria for particular sports. The intent of this manuscript is to present such a rehabilitation protocol for basketball. PMID:22465899

Waters, Eric

2012-04-01

321

An ambulatory method of identifying anterior cruciate ligament reconstructed gait patterns.  

PubMed

The use of inertial sensors to characterize pathological gait has traditionally been based on the calculation of temporal and spatial gait variables from inertial sensor data. This approach has proved successful in the identification of gait deviations in populations where substantial differences from normal gait patterns exist; such as in Parkinsonian gait. However, it is not currently clear if this approach could identify more subtle gait deviations, such as those associated with musculoskeletal injury. This study investigates whether additional analysis of inertial sensor data, based on quantification of gyroscope features of interest, would provide further discriminant capability in this regard. The tested cohort consisted of a group of anterior cruciate ligament reconstructed (ACL-R) females and a group of non-injured female controls, each performed ten walking trials. Gait performance was measured simultaneously using inertial sensors and an optoelectronic marker based system. The ACL-R group displayed kinematic and kinetic deviations from the control group, but no temporal or spatial deviations. This study demonstrates that quantification of gyroscope features can successfully identify changes associated with ACL-R gait, which was not possible using spatial or temporal variables. This finding may also have a role in other clinical applications where small gait deviations exist. PMID:24451464

Patterson, Matthew R; Delahunt, Eamonn; Sweeney, Kevin T; Caulfield, Brian

2014-01-01

322

Anterior cruciate ligament regeneration using mesenchymal stem cells and silk scaffold in large animal model.  

PubMed

Although in vivo studies in small animal model show the ligament regeneration by implanting mesenchymal stem cells (MSCs) and silk scaffold, large animal studies are still needed to evaluate the silk scaffold before starting a clinical trial. The aim of this study is to regenerate anterior cruciate ligament (ACL) in pig model. The micro-porous silk mesh was fabricated by incorporating silk sponges into knitted silk mesh with lyophilization. Then the scaffold was prepared by rolling the micro-porous silk mesh around a braided silk cord to produce a tightly wound shaft. In vitro study indicated that MSCs proliferated profusely on scaffold and differentiated into fibroblast-like cells by expressing collagen I, collagen III and tenascin-C genes in mRNA level. Then the MSCs-seeded scaffold was implanted in pig model to regenerate ACL. At 24 weeks postoperatively, the MSCs in regenerated ligament exhibited fibroblast morphology. The key ligament-specific extracellular matrix components were produced prominently and indirect ligament-bone insertion with three zones (bone, Sharpey's fibers and ligament) was observed. Although there was remarkable scaffold degradation, the maximum tensile load of regenerated ligament could be maintained after 24 weeks of implantation. In conclusion, the results imply that silk-based material has great potentials for clinical applications. PMID:19539988

Fan, Hongbin; Liu, Haifeng; Toh, Siew L; Goh, James C H

2009-10-01

323

New strategies for anterior cruciate ligament partial rupture using bone marrow transplantation in rats.  

PubMed

The purpose of this study was to compare anterior cruciate ligament (ACL) regeneration between animal groups subjected to intra-articular injection of fresh whole bone marrow cells (BMCs), cultured mesenchymal stem cells (MSCs), or saline. Partially transected ACLs in Fischer 344/Nslc rats were prepared, followed by injection of BMCs, MSCs, or saline into the articular cavity at 1 week after transection. Donor cells expressing green fluorescent protein were detected in the recipient's transected ACLs at 4 weeks in the BMC and MSC groups, and their ACLs appeared almost normal histologically. Further, there were significantly more mature spindle cells in the BMC group than in the saline group at 4 weeks. Biomechanically, the tensile strength in the BMC group reached near normal levels at 4 weeks after injection. The levels of transforming growth factor-?1 in the ACL tissue and knee joint fluid in the BMC group were increased significantly compared with that of the saline group at 4 weeks as detected by immunohistochemical analysis. In conclusion, intra-articular bone marrow transplantation using fresh whole BMCs is an effective treatment for ACL partial rupture. This therapy is easy to apply in a clinical setting because no culture system is required for collecting MSCs. PMID:20809695

Oe, Kenichi; Kushida, Taketoshi; Okamoto, Naofumi; Umeda, Masayuki; Nakamura, Tomohisa; Ikehara, Susumu; Iida, Hirokazu

2011-04-01

324

In vivo study of anterior cruciate ligament regeneration using mesenchymal stem cells and silk scaffold.  

PubMed

Although most in vitro studies indicate that silk is a suitable biomaterial for ligament tissue engineering, in vivo studies of implanted silk scaffolds for ligament reconstruction are still lacking. The objective of this study is to investigate anterior cruciate ligament (ACL) regeneration using mesenchymal stem cells (MSCs) and silk scaffold. The scaffold was fabricated by incorporating microporous silk sponges into knitted silk mesh, which mimicked the structures of ligament extracellular matrix (ECM). In vitro culture demonstrated that MSCs on scaffolds proliferated vigorously and produced abundant collagen. The transcription levels of ligament-specific genes also increased with time. Then MSCs/scaffold was implanted to regenerate ACL in vivo. After 24 weeks, histology observation showed that MSCs were distributed throughout the regenerated ligament and exhibited fibroblast morphology. The key ligament ECM components including collagen I, collagen III, and tenascin-C were produced prominently. Furthermore, direct ligament-bone insertion with typical four zones (bone, mineralized fibrocartilage, fibrocartilage, ligament) was reconstructed, which resembled the native structure of ACL-bone insertion. The tensile strength of regenerated ligament also met the mechanical requirements. Moreover, its histological grading score was significantly higher than that of control. In conclusion, the results imply that silk scaffold has great potentials in future clinical applications. PMID:18462787

Fan, Hongbin; Liu, Haifeng; Wong, Eugene J W; Toh, Siew L; Goh, James C H

2008-08-01

325

Growth factors and stem cells for the management of anterior cruciate ligament tears.  

PubMed

The anterior cruciate ligament (ACL) is fundamental for the knee joint stability. ACL tears are frequent, especially during sport activities, occurring mainly in young and active patients. Nowadays, the gold standard for the management of ACL tears remains the surgical reconstruction with autografts or allografts. New strategies are being developed to resolve the problems of ligament grafting and promote a physiological healing process of ligamentous tissue without requiring surgical reconstruction. Moreover, these strategies can be applicable in association surgical reconstruction and may be useful to promote and accelerate the healing process. The use of growth factors and stem cells seems to offer a new and fascinating solution for the management of ACL tears. The injection of stem cell and/or growth factors in the site of ligamentous injury can potentially enhance the repair process of the physiological tissue. These procedures are still at their infancy, and more in vivo and in vitro studies are required to clarify the molecular pathways and effectiveness of growth factors and stem cells therapy for the management of ACL tears. This review aims to summarize the current knowledge in the field of growth factors and stem cells for the management of ACL tears. PMID:23248722

Rizzello, Giacomo; Longo, Umile Giuseppe; Petrillo, Stefano; Lamberti, Alfredo; Khan, Wasim Sardar; Maffulli, Nicola; Denaro, Vincenzo

2012-01-01

326

Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review  

PubMed Central

Background Numerous clinical tests are used in the diagnosis of anterior cruciate ligament (ACL) injury but their accuracy is unclear. The purpose of this study is to evaluate the diagnostic accuracy of clinical tests for the diagnosis of ACL injury. Methods Study Design: Systematic review. The review protocol was registered through PROSPERO (CRD42012002069). Electronic databases (PubMed, MEDLINE, EMBASE, CINAHL) were searched up to 19th of June 2013 to identify diagnostic studies comparing the accuracy of clinical tests for ACL injury to an acceptable reference standard (arthroscopy, arthrotomy, or MRI). Risk of bias was appraised using the QUADAS-2 checklist. Index test accuracy was evaluated using a descriptive analysis of paired likelihood ratios and displayed as forest plots. Results A total of 285 full-text articles were assessed for eligibility, from which 14 studies were included in this review. Included studies were deemed to be clinically and statistically heterogeneous, so a meta-analysis was not performed. Nine clinical tests from the history (popping sound at time of injury, giving way, effusion, pain, ability to continue activity) and four from physical examination (anterior draw test, Lachman’s test, prone Lachman’s test and pivot shift test) were investigated for diagnostic accuracy. Inspection of positive and negative likelihood ratios indicated that none of the individual tests provide useful diagnostic information in a clinical setting. Most studies were at risk of bias and reported imprecise estimates of diagnostic accuracy. Conclusion Despite being widely used and accepted in clinical practice, the results of individual history items or physical tests do not meaningfully change the probability of ACL injury. In contrast combinations of tests have higher diagnostic accuracy; however the most accurate combination of clinical tests remains an area for future research. Clinical relevance Clinicians should be aware of the limitations associated with the use of clinical tests for diagnosis of ACL injury. PMID:25187877

2014-01-01

327

Effect of knee musculature on anterior cruciate ligament strain in vivo.  

PubMed

Squatting is a commonly prescribed exercise following reconstruction of the anterior cruciate ligament (ACL). The objective of this paper was to measure the in vivo strain patterns of the normal ACL and the load at the knee for the simple squat and for squatting with a "sport cord". A sport cord is a large elastic rubber tube used for added resistance. Strain patterns were deduced using displacement data from a Hall Effect Strain Transducer (HEST), while joint loads were determined by a mathematical model with inputs from a force plate and electrogoniometers. ACL strain for the free squat in one subject had a maximum of ?2% at a knee angle of 10° and was slack for knee angles >17°. In squatting with a sport cord, peak strain was ?1% at 10° and was slack at knee angles >14°. Since these peak strains are low, squatting appears to be a safe exercise for conservative rehabilitation of ACL reconstruction patients. In addition, the sport cord is a recommended augmentation to the activity. We believe that the decrease in strain with the sport cord results from added joint stiffness due to greater compressive forces at the tibiofemoral joint. This greater compressive force results from the approximately 10% increase in quadriceps activity. From shear force data predicted by the mathematical model, the maximum anterior drawer force for free squatting (50 N) was considerably less than for sport cord squatting (430 N). Therefore, the value of shear force at the tibiofemoral joint only partially determines the load placed on the ACL. PMID:20870509

Pope, M H; Stankewich, C J; Beynnon, B D; Fleming, B C

1991-09-01

328

Radiographic findings in revision anterior cruciate ligament reconstructions from the Mars cohort.  

PubMed

The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature. PMID:23404491

2013-08-01

329

Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort  

PubMed Central

The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature. PMID:23404491

2013-01-01

330

A Comparison of Functional Outcomes After Metallic and Bioabsorbable Interference Screw Fixations in Arthroscopic ACL Reconstructions  

PubMed Central

Introduction: Anterior Cruciate Ligament (ACL) is as one of the most frequently injured ligaments in the modern contact sports scenario. Graft fixations can be achieved during anterior cruciate ligament (ACL) reconstructions by using either bioabsorbable screws or metal screws. The objective of this study was to compare the functional outcomes after bioabsorbable and metallic interference screw fixations in arthroscopic anterior cruciate ligament reconstructions done by using hamstring grafts. Materials and Methods: This was a prospective, randomized study. Patients in Group 1 received bioabsorbable interference screws and patients in Group 2 received metallic interference screws. Arthroscopic assisted, anterior cruciate ligament reconstructions with the use of hamstring grafts which were fixed proximally with endobuttons and distally with bioabsorbable or metallic interference screws, were undertaken. Progress in functional outcomes was assessed by using Mann Whitney U- test. Functional outcomes in the two groups were compared by using independent t-test. Observation and Results: In each group, there were statistically significant improvements in functional outcomes over successive follow-ups, which were seen on basis on Mann-Whitney U-test. The comparison of functional outcomes between the two groups, done by using independent t-test, showed no statistically significant differences between the two groups at 3 months, 6 months and 1 year of follow-up. p-value <0.05 was considered to be significant in our study. Conclusion: In our prospective study of comparison of functional outcomes between bioabsorbable and metallic interference screws in arthroscopic anterior cruciate ligament reconstuctions, which were evaluated by using Tegner activity scale and Lysholm knee scoring scale for a period of 1 year, no statistically significant difference was found. However, further authentication is required by doing long term studies. PMID:24959468

Rai, Deepak K; Kannampilly, Antony J

2014-01-01

331

Histological characteristics and ultrastructure of polyethylene terephthalate LARS ligament after the reconstruction of anterior cruciate ligament in rabbits  

PubMed Central

Polyethylene terephthalate LARS ligament were the remnant of LARS ligament used for repairing posterior cruciate ligament obtained from operation. We want to study histological characteristics and ultrastructure of polyethylene terephthalate LARS ligament after the reconstruction of anterior cruciate ligament in rabbits. Therefore, we replaced the original ACL with polyethylene terephthalate LARS ligament which was covering with the remnant of ACL in 9 rabbits (L-LARS group), while just only polyethylene terephthalate LARS ligament were transplanted in 3 rabbits (LARS group) with the remnant of ACL. Compared with group LARS, inflammatory cell reaction and foreign body reaction were more significant in group L-LARS. Moreover, electron microscopy investigation showed the tissue near LARS fibers was highly cellular with a matrix of thin collagen fibrils (50-100 nm) in group L-LARS. These above findings suggest the polyethylene terephthalate LARS ligament possess the high biocompatibility, which contributes to the polyethylene terephthalate LARS covered with recipient connective tissues. PMID:25356104

Yu, Shao-Bin; Yang, Rong-Hua; Zuo, Zhong-Nan; Dong, Qi-Rong

2014-01-01

332

A Cadaver Study of the Structures and Positions of the Anterior Cruciate Ligament in Humans  

PubMed Central

Background: The anterior cruciate ligament (ACL) is one of the major knee structures. It consists of anteromedial bundle (AMB) and posterolateral bundle (PLB). Rupture of the ACL is one of the most prevalent traumas among athletes. There are two ways to reconstruct the rupture; Single–bundle and double–bundle (DB) reconstruction. Precise study on bundles anatomy, the exact number of attachments and knee flexion angle with an appropriate place of bundles and also choosing the best angle for the grafts are so important in successful reconstructing of the bundles. In this research, the general attempt was to assess anatomy and the act of the ACL is and bundles in Iranian population. Methods: We obtained twelve fresh-frozen cadaver knees (two females, ten males). The average age of them was 30 years; they were mostly between 27 and 34 years old. Initially, skin, muscles, and patellar and articular capsule were removed. Then, bundle attachments, knee movements in flexion angle, extension and stiffness of both bundles were evaluated. Thereafter, on 0, 30, 60, 90, 120, and 180° angle knee flexion the bundles degree stiffness evaluated in different directions. During the process, to measure bundles size, digital camera for photography, oblique for measuring the angles, and micrometer were utilized. From all next of kin written consent testimonial form was obtained. Results: In all knees, two bundles were identified as distinct. AMB attachment location in the anterior region observed as semi-lunate and in one case, it was rounded. In all cases, two bundles of full knee extension were paralleled, and the AMB was anterior to the PLB; with increasing flexion angle, femoral attachment location of AMB was in back direction and femoral attachment location of PLB moved toward the front direction. Two bundles were in the most amount of cross state, which the angle was 90°. From the stiffness point of view in all 6 samples, the PLB had the most tension in extension state, and the AMB had the most tension in 120° flexion. Conclusion: In the current study, we realized that the ACL is a DB ligament in Iranian population. The AMB in full extension has the least stiffness and in 90° flexion has the most; the PLB also in full knee extension and in 160° flexion has the most and least stiffness, respectively. PMID:23717777

Moghaddam, Ahmad Bagheri; Torkaman, Ali

2013-01-01

333

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment  

PubMed Central

Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining conditions can be improved by introducing a new suturing technique and by using small intestinal submucosa (SIS) as a bioscaffold. It is hypothesized that the suturing technique keep the torn ends together and that SIS enhance and promote the healing of the ACL. The goat was used as the study model. In the Suture group, the left ACL was transected and suture repaired with a new locking suture repair technique (n=5) allowing approximation and fixation under tension. The Suture-SIS group underwent the same procedure with the addition of SIS (n=5). The right ACL served as control. After 12 weeks of healing, anterior–posterior translation and in situ force of the healing ACL were measured, followed by the measurement of the cross-sectional area and structural stiffness. Routine histology was performed on tissue samples. Gross morphology showed that the healing ACL was continuous with collagenous tissue in both groups. The cross-sectional area of the Suture and the Suture-SIS group was 35% and 50% of the intact control, respectively. The anterior–posterior translations at different flexion angles were statistically not different between the Suture group and the Suture-SIS group. Only the in situ force at 30° in the Suture-SIS group was higher than in the Suture group. Tensile tests showed that the stiffness for the Suture group was not different from the Suture-SIS group (31.1±8.1?N/mm vs. 41.9±18.0?N/mm [p>0.05]). Histology showed longitudinally aligned collagen fibers from origo to insertion. More fibroblasts were present in the healing tissue than in the control intact tissue. The study demonstrated the proof of concept of ACL repair in a goat model with a new suture technique and SIS. The mechanical outcome is not worse than previously reported for ACL reconstruction. In conclusion, the approach of using a new suture technique, with or without a bioscaffold to heal the ACL is promising. PMID:23725556

Geel, Jurre; Schulze, Martin; Raschke, Michael J.; Woo, Savio L-Y.; van Dijk, C. Niek; Blankevoort, Leendert

2013-01-01

334

The anterior cruciate ligament injury controversy: is “valgus collapse” a sex-specific mechanism?  

PubMed Central

Background Anterior cruciate ligament (ACL) injury is a devastating injury that puts an athlete at high risk of future osteoarthritis. Identification of risk factors and development of ACL prevention programmes likely decrease injury risk. Although studies indicate that sagittal plane biomechanical factors contribute to ACL loading mechanisms, it is unlikely that non-contact ACL injuries occur solely in a sagittal plane. Some authors attempt to ascribe the solely sagittal plane injury mechanism to both female and male ACL injuries and rebuff the concept that knee “valgus” is associated with isolated ACL injury. Prospective studies that utilise coupled biomechanical and epidemiological approaches demonstrated that frontal knee motions and torques are strong predictors of future non-contact ACL injury risk in female athletes. Video analysis studies also indicate a frontal plane “valgus collapse” mechanism of injury in women. As load sharing between knee ligaments is complex, frontal as well as sagittal and transverse plane loading mechanisms likely contribute to non-contact ACL injury. The purpose of this review is to summarise existing evidence regarding ACL injury mechanisms and to propose that sex-specific mechanisms of ACL injury may occur, with women sustaining injuries by a predominantly “valgus collapse” mechanism. Conclusion Prevention programmes and interventions that only target high-risk sagittal plane landing mechanics, especially in the female athlete, are likely to be less effective in ameliorating important frontal and transverse plane contributions to ACL injury mechanisms and could seriously hamper ACL injury prevention efforts. Programmes that target the reduction of high-risk valgus and sagittal plane movements will probably prove to be superior for ACL injury prevention. PMID:19372087

Quatman, CE; Hewett, TE

2014-01-01

335

Knee moments of anterior cruciate ligament reconstructed and control participants during normal and inclined walking  

PubMed Central

Objectives Prior injury to the knee, particularly anterior cruciate ligament (ACL) injury, is known to predispose one to premature osteoarthritis (OA). The study sought to explore if there was a biomechanical rationale for this process by investigating changes in external knee moments between people with a history of ACL injury and uninjured participants during walking: (1) on different surface inclines and (2) at different speeds. In addition we assessed functional differences between the groups. Participants 12 participants who had undergone ACL reconstruction (ACLR) and 12 volunteers with no history of knee trauma or injury were recruited into this study. Peak knee flexion and adduction moments were assessed during flat (normal and slow speed), uphill and downhill walking using an inclined walkway with an embedded Kistler Force plate, and a ten-camera Vicon motion capture system. Knee injury and Osteoarthritis Outcome Score (KOOS) was used to assess function. Multivariate analysis of variance (MANOVA) was used to examine statistical differences in gait and KOOS outcomes. Results No significant difference was observed in the peak knee adduction moment between ACLR and control participants, however, in further analysis, MANOVA revealed that ACLR participants with an additional meniscal tear or collateral ligament damage (7 participants) had a significantly higher adduction moment (0.33±0.12?Nm/kg?m) when compared with those with isolated ACLR (5 participants, 0.1±0.057?Nm/kg?m) during gait at their normal speed (p<0.05). A similar (non-significant) trend was seen during slow, uphill and downhill gait. Conclusions Participants with an isolated ACLR had a reduced adductor moment rather an increased moment, thus questioning prior theories on OA development. In contrast, those participants who had sustained associated trauma to other key knee structures were observed to have an increased adduction moment. Additional injury concurrent with an ACL rupture may lead to a higher predisposition to osteoarthritis than isolated ACL deficiency alone. PMID:24898088

Varma, Raghav K; Duffell, Lynsey D; Nathwani, Dinesh; McGregor, Alison H

2014-01-01

336

Pre-operative quadriceps strength predicts IKDC2000 scores 6 months after anterior cruciate ligament reconstruction  

PubMed Central

Background Quadriceps strength deficits are ubiquitous after anterior cruciate ligament (ACL) injury. Deficits prior to surgery can influence knee function post-operatively. Inhibition contributes to quadriceps strength deficits after an ACL injury. Body mass index, meniscal injury, and sex influence functional outcomes after ACL reconstruction. The purpose of this study is to examine the relationship of pre-operative quadriceps strength and post-operative knee function and to investigate how other pre-operative factors may influence this relationship. Methods After an ACL injury, subjects received pre-operative rehabilitation and performed quadriceps strength testing. Subjects underwent reconstruction and post-operative rehabilitation. Six months after ACL reconstruction, subjects completed the International Knee Documentation Committee 2000 subjective form (IKDC2000). Linear regression models were developed using IKDC2000 scores at 6 months after ACL reconstruction as the dependent variable. Results Fifty-five subjects had complete pre-operative data and IKDC2000 scores at 6 months after ACL reconstruction. Pre-operative involved quadriceps strength was a significant predictor for IKDC2000 scores 6 months after ACL reconstruction. Sex, meniscal injury, pre-operative BMI, and pre-operative involved quadriceps activation ratio were not significant predictors in the regression model. Conclusions Pre-operative quadriceps strength can predict IKDC2000 scores 6 months after ACL reconstruction. Deficits in pre-operative quadriceps strength influence self-reported function 6 months after surgery. Factors that are known to influence quadriceps strength and self-reported outcomes do not influence the relationship between pre-operative quadriceps strength and post-operative IKDC2000 scores. PMID:23022031

Logerstedt, David; Lynch, Andrew; Axe, Michael J.; Snyder-Mackler, Lynn

2012-01-01

337

Postural stability does not differ among female sports with high risk of anterior cruciate ligament injury.  

PubMed

Dancers have a lower incidence of anterior cruciate ligament (ACL) injury compared to athletes in sports that involve cutting and landing motions. Balance can impact ACL injury risk and is related to neuromuscular control during movement. The purpose of this study was to investigate whether balance differences exist among female dancers and female soccer and basketball athletes. Fifty-eight female dancers, soccer, and basketball athletes (16.5 ± 1.6 yrs, 1.6 ± 0.2 m, 60.2 ± 14.1 kg) completed the Stability Evaluation Test (SET) on the NeuroCom VSR Sport (NeuroCom International, Clackamas, OR) to measure sway velocity. Video records of the SET test were used for Balance Error Scoring System (BESS) test scoring. A oneway ANCOVA compared composite sway velocity and BESS scores among sports. There was no statistically significant difference for sway velocity or BESS among sports (sway velocity soccer 2.3 ± 0.4, dance 2.2 ± 0.4, and basketball 2.4 ± 0.4; BESS soccer 13.6 ± 5.0, dance 11.9 ± 5.5, and basketball 14.9 ± 5.1, p>0.05). Balance was similar among athletes participating in different sports (dance, basketball, and soccer). Quasi-static balance may not play a significant role in neuromuscular control during movement and not be a significant risk factor to explain the disparity in ACL injury incidence among sports. Future research should examine the effects of dynamic balance and limb asymmetries among sports to elucidate on the existing differences on ACL injury incidence rates. PMID:25433258

Cortes, Nelson; Porter, Larissa D; Ambegaonkar, Jatin P; Caswell, Shane V

2014-12-01

338

Effect of Donor Age on the Proportion of Mesenchymal Stem Cells Derived from Anterior Cruciate Ligaments  

PubMed Central

The characteristics of anterior cruciate ligament (ACL)-derived mesenchymal stem cells (MSCs), such as proportion and multilineage potential, can be affected by donor age. However, the qualitative and quantitative features of ACL MSCs isolated from younger and older individuals have not yet been compared directly. This study assessed the phenotypic and functional differences in ACL-MSCs isolated from younger and older donors and evaluated the correlation between ACL-MSC proportion and donor age. Torn ACL remnants were harvested from 36 patients undergoing ACL reconstruction (young: 29.67 ± 10.92 years) and 33 undergoing TKA (old: 67.96 ± 5.22 years) and the proportion of their MSCs were measured. The mean proportion of MSCs was slightly higher in older ACL samples of the TKA group than of the younger ACL reconstruction group (19.69 ± 8.57% vs. 15.33 ± 7.49%, p = 0.024), but the proportions of MSCs at passages 1 and 2 were similar. MSCs from both groups possessed comparable multilineage potentiality, as they could be differentiated into adipocytes, osteocytes, and chondrocytes at similar level. No significant correlations were observed between patient age and MSC proportions at passages 0–2 or between age and MSC proportion in both the ACL reconstruction and TKA groups. Multiple linear regression analysis found no significant predictor of MSC proportion including donor age for each passage. Microarray analysis identified several genes that were differentially regulated in ACL-MSCs from old TKA patients compared to young ACL reconstruction patients. Genes of interest encode components of the extracellular matrix (ECM) and may thus play a crucial role in modulating tissue homeostasis, remodeling, and repair in response to damage or disease. In conclusion, the proportion of freshly isolated ACL-MSC was higher in elderly TKA patients than in younger patients with ACL tears, but their phenotypic and multilineage potential were comparable. PMID:25729860

Lee, Dae-Hee; Ng, Joanne; Kim, Sang-Beom; Sonn, Chung Hee; Lee, Kyung-Mi; Han, Seung-Beom

2015-01-01

339

Anterior cruciate ligament elasticity and force for flexion during the menstrual cycle  

PubMed Central

Background A high occurrence of knee injuries have been observed in women during the menstrual cycle (MC). As a result, numerous studies have been conducted regarding knee ligament elasticity during the MC. Some researchers believe that since estrogen receptor b exists in ligaments and tendons in the knee, estrogen may modulate towards a state of laxity. However, increased tissue temperature also observed during the MC can predispose ligament and tendon laxness. Therefore, the purpose of this study was to assess in women the relationship between Estradiol (E2) serum concentrations and tissue temperature during the MC and their combined effect on knee laxity. Material/Methods Ten non-athletic young healthy females, 18 to 30 years of age participated in the study. E2 serum concentrations, anterior cruciate ligament (ACL) elasticity, and force to flex the knee (FFK), knee flexion-extension hysteresis (KFEH) were assessed both at ambient temperature (22°C) and after 38°C warming. Testing was performed multiple times during the participant’s MC, for one full MC. Results ACL elasticity was significantly higher (P<0.01) and FFK and KFEH were significantly lower (p<0.05) during ovulation when E2 levels were highest. ACL elasticity was still higher during ovulation after warming to 38°C. But, the effects of MC on FFK and KFEH were reduced by tissue warming. Conclusions ACL elasticity, FFK, and KFEH was affected not only by E2 but also tissue temperature. However, E2 had more impact on ACL elasticity while tissue temperature had more impact on FFK and KFEH at 38°C warming. PMID:24287619

Lee, Haneul; Petrofsky, Jerrold S.; Daher, Noha; Berk, Lee; Laymon, Michale; Khowailed, Iman Akef

2013-01-01

340

Proteomic Differences between Male and Female Anterior Cruciate Ligament and Patellar Tendon  

PubMed Central

The risk of anterior cruciate ligament (ACL) injury and re-injury is greater for women than men. Among other factors, compositional differences may play a role in this differential risk. Patellar tendon (PT) autografts are commonly used during reconstruction. The aim of the study was to compare protein expression in male and female ACL and PT. We hypothesized that there would be differences in key structural components between PT and ACL, and that components of the proteome critical for response to mechanical loading and response to injury would demonstrate significant differences between male and female. Two-dimensional liquid chromatography-tandem mass spectrometry and a label-free quantitative approach was used to identify proteomic differences between male and female PT and ACL. ACL contained less type I and more type III collagen than PT. There were tissue-specific differences in expression of proteoglycans, and ACL was enriched in elastin, tenascin C and X, cartilage oligomeric matrix protein, thrombospondin 4 and periostin. Between male and female donors, alcohol dehydrogenase 1B and complement component 9 were enriched in female compared to male. Myocilin was the major protein enriched in males compared to females. Important compositional differences between PT and ACL were identified, and we identified differences in pathways related to extracellular matrix regulation, complement, apoptosis, metabolism of advanced glycation end-products and response to mechanical loading between males and females. Identification of proteomic differences between male and female PT and ACL has identified novel pathways which may lead to improved understanding of differential ACL injury and re-injury risk between males and females. PMID:24818782

Little, Dianne; Thompson, J. Will; Dubois, Laura G.; Ruch, David S.; Moseley, M. Arthur; Guilak, Farshid

2014-01-01

341

Increased in-vivo tibiofemoral cartilage contact deformation in anterior cruciate ligament-deficiency  

PubMed Central

Objective To investigate the in-vivo cartilage contact biomechanics of the tibiofemoral joint following anterior cruciate ligament (ACL) injury. Methods Eight patients with an isolated ACL injury in one knee and the contralateral side intact participated in the study. Both knees were imaged using a specific MR sequence to create three-dimensional knee models of bone and cartilage. Next, each patient performed a lunge as images were recorded with a dual fluoroscopic system from 0° to 90° of flexion. The three-dimensional knee models and fluoroscopic images were used to reproduce the in-vivo knee position at each flexion angle. With these series of knee models, the location of tibiofemoral cartilage contact, size of contact area, cartilage thickness at the contact area, and magnitude of cartilage contact deformation were compared between the intact and ACL-deficient knees. Results Rupture of the ACL changed the cartilage contact biomechanics from 0° to 60° of flexion in the medial knee compartment. The location of peak cartilage contact deformation on the tibial plateaus was more posterior and lateral; the contact area was smaller; the average cartilage thickness at the tibial cartilage contact area was thinner; and the resultant magnitude of cartilage contact deformation was increased, compared with the contralateral knee. Similar changes were observed in the lateral compartment, with increased cartilage contact deformation from 0° to 30° of knee flexion in ACL deficiency. Conclusion ACL deficiency alters the in-vivo cartilage contact biomechanics, by shifting the contact location to smaller regions of thinner cartilage, and increasing the magnitude of cartilage contact deformation. PMID:19950260

Van de Velde, Samuel K.; Bingham, Jeffrey T.; Hosseini, Ali; Kozanek, Michal; DeFrate, Louis E.; Gill, Thomas J.; Li, Guoan

2010-01-01

342

In vivo anterior cruciate ligament strain behaviour during a rapid deceleration movement: case report.  

PubMed

The mechanism of anterior cruciate ligament (ACL) injury is still unclear. To gain this insight, knowledge of the mechanical behaviour of the healthy ACL during activities that may stress the ligament must be investigated in vivo. The goal of this research was to measure ACL strain in vivo during rapid deceleration, a sport type movement that has been previously shown to precede injuries to the ACL in healthy subjects. A young male subject with no previous knee joint injuries volunteered after informed consent. The strain gauge device (DVRT) was calibrated and surgically implanted in the antero-medial band of the intact ACL. The subject was then transported to the lab for data collection. The zero strain position of the ACL was determined using the slack-taut technique. The subject hopped as quickly as possible from a distance of 1.5 m to the target, an X taped at the centre of a force plate, landing with the instrumented left leg and stopping in the landed position. The entire collection window was five seconds at 1000 Hz. A total of three rapid deceleration trials were collected and averaged over the hop cycle. The slack-taut test was then repeated to ensure proper operation of the DVRT and the reliability of the results. The results showed an average peak strain of the ACL during the instrumented Lachman test of 2.00+/-0.17%. The average peak strain of the ACL during the rapid deceleration task was 5.47+/-0.28%. The data indicate that the RD task caused an increase in peak ACL strain that is much higher than during the instrumented Lachman test, and that the strain begins to increase during the flight phase, prior to landing, and reaches a peak that corresponds to the peak ground reaction force. This technique may be used in further sport-specific movements to gain insight into movement patterns associated with ACL injury mechanisms. PMID:14523613

Cerulli, G; Benoit, D L; Lamontagne, M; Caraffa, A; Liti, A

2003-09-01

343

Cervical lordosis in patients who underwent anterior cruciate ligament injury: a cross-sectional study.  

PubMed

It has been proposed that intraoral devices can influence cervical posture. Cervical posture might also be influenced by stimuli from the lower limbs, such as injury of the knee. The hypothesis to be tested is that intraoral devices are useful during the rehabilitation of orthopedic patients to accelerate the restoration of postural control. This study evaluates cervical posture on lateral skull radiographs in subjects who suffered anterior cruciate ligament (ACL) injury of the left knee. Twenty adult Caucasian males (mean age 30.6+/-9.2 yrs.) with ACL injury of the left knee were compared with 40 control subjects (mean age 27.9+/-7.2) who did not show any ACL injury. Lateral skull radiographs, made in natural head position (mirror position), were obtained for all subiects. Various postural and morphological variables were individualized on each radiograph. To assess errors due to landmark identification, duplicate measurements were made of 15 radiographs and compared using the Dahlberg formula. The method error from both sources was less than 0.5 degrees for all angular measurements and less than 0.5 mm for all linear measurements. No difference was observed between the two groups in any of the morphological variables of face or in the cervical lordosis angle (CVT/EVT). However, subjects in the study group showed significantly higher craniocervical angulations (SN/OPT, SN/CVT, SN/EVT, pns-ans/OPT, pns-ans/CVT, pns-ans/EVT, GoGn/OPT, GoGn/CVT, GoGn/EVT) compared with the control subjects (p<0.001). The subjects with ACL injury had significant head extension compared with the control subjects. PMID:17304917

Tecco, Simona; Colucci, Christian; Caraffa, Auro; Salini, Vincenzo; Festa, Felice

2007-01-01

344

Collagen scaffold supplementation does not improve the functional properties of the repaired anterior cruciate ligament.  

PubMed

Primary suture anterior cruciate ligament (ACL) repair was abandoned in favor of reconstruction due to a high rate of clinical failures. However, the insertion of a collagen scaffold loaded with platelets into the wound at the time of suture repair ("enhanced primary repair") has been shown to improve functional healing in animal models. Our objectives were to determine if using a collagen scaffold alone (without platelets) would be sufficient to increase the structural properties of the repaired ACL and decrease postoperative knee laxity compared to suture repair without the scaffold. Eight Yucatan minipigs underwent bilateral ACL transection and suture repair. In one knee, the repair was augmented with a collagen scaffold (SCAFFOLD group) while the other had suture alone (SUTURE group). After 13 weeks of healing, knee joint laxity and the structural properties of the ACL were measured. The addition of the collagen scaffold to suture repair of a transected ACL did not significantly improve the mean anteroposterior knee laxity [SCAFFOLD vs. SUTURE: 6.1 +/- 1.4 vs. 4.4 +/- 2.0 mm (p = 0.07), 8.1 +/- 2.0 vs. 7.6 +/- 2.0 mm (p = 0.66), and 6.2 +/- 1.2 vs. 6.1 +/- 1.8 mm (p = 0.85) at 30 degrees, 60 degrees, and 90 degrees flexion, respectively]. Likewise, there were no significant differences in the structural properties [SCAFFOLD vs. SUTURE: 367 +/- 185.9 vs. 322 +/- 122.0N (p = 0.66) and 90.7 +/- 29.5 vs. 85.0 +/- 30.3N/mm (p = 0.74) for the yield load and linear stiffness, respectively]. The use of a collagen scaffold alone to enhance suture repair of the ACL was ineffective in this animal model. Future work will be directed at stimulating biological activity in the scaffold. PMID:20058276

Fleming, Braden C; Magarian, Elise M; Harrison, Sophia L; Paller, David J; Murray, Martha M

2010-06-01

345

Cellular and extracellular matrix changes in anterior cruciate ligaments during human knee aging and osteoarthritis  

PubMed Central

Introduction Anterior cruciate ligament (ACL) degeneration is observed in most osteoarthritis (OA)-affected knee joints. However, the specific spatial and temporal relations of these changes and their association with extracellular matrix (ECM) degeneration are not well understood. The objective of this study was to characterize the patterns and relations of aging-related and OA-associated changes in ACL cells and the ECM. Methods Human knee joints from 80 donors (age 23 through 94) were obtained at autopsy. ACL degeneration was assessed histologically by using a quantitative scoring system. Tissue sections were analyzed for cell density, cell organization, ECM components, ECM-degrading enzymes and markers of differentiation, proliferation, and stem cells. Results Total cell number in normal ACL decreased with aging but increased in degenerated ACL, because of the formation of perivascular cell aggregates and islands of chondrocyte-like cells. Matrix metalloproteinase (MMP)-1, -3, and -13 expression was reduced in aging ACL but increased in degenerated ACL, mainly in the chondrocyte-like cells. Collagen I was expressed throughout normal and degenerated ACL. Collagen II and X were detected only in the areas with chondroid metaplasia, which also expressed collagen III. Sox9, Runt-related transcription factor 2 (Runx2), and scleraxis expression was increased in the chondrocyte-like cells in degenerated ACL. Alpha-smooth muscle actin (?-SMA), a marker of myofibroblasts and the progenitor cell marker STRO-1, decreased with aging in normal ACL. In degenerated ACL, the new cell aggregates were positive for ?-SMA and STRO-1. Conclusions ACL aging is characterized by reduced cell density and activation. In contrast, ACL degeneration is associated with cell recruitment or proliferation, including progenitor cells or myofibroblasts. Abnormally differentiated chondrocyte-like cell aggregates in degenerated ACL produce abnormal ECM and may predispose to mechanical failure. PMID:23406989

2013-01-01

346

Transcription factor Mohawk and the pathogenesis of human anterior cruciate ligament degradation  

PubMed Central

Objective To investigate the expression and function of Mohawk (MKX) in human adult anterior cruciate ligament (ACL) tissues and ligament cells from normal and osteoarthritis-affected knees. Methods Knee joints were obtained at autopsy within 24-48 hours postmortem from 13 normal donors (age 36.9±11.0 years), 16 OA donors (age 79.7±11.4 years) and 8 old donors without OA (age 76.9±12.9 years). All cartilage surfaces were graded macroscopically. MKX expression was analyzed by immunohistochemistry and quantitative PCR. ACL-derived cells were used to study regulation of MKX expression by IL-1?. MKX was knocked down by siRNA to analyze function of MKX in extracellular matrix (ECM) production and differentiation in ACL-derived cells. Results The expression of MKX was significantly decreased in ACL-derived cells from OA knees compared with normal knees. Consistent with this finding, immunohistochemistry showed that MKX positive cells were significantly reduced in ACL tissues from OA donors in particular in cells located in disorientated fibers. In ACL-derived cells, IL-1? strongly suppressed MKX gene expression and reduced ligament ECM genes, COL1A1 and TNXB. On the other hand, SOX9, chondrocyte master transcription factor, was up regulated by IL-1? treatment. Importantly, knock down of MKX expression by siRNA upregulated SOX9 expression in ACL-derived cells, whereas the expression of COL1A1 and TNXB were decreased. Conclusion Reduced expression of MKX is a feature of degenerated ACL in OA-affected joints and this may be in part mediated by IL-1?. MKX appears necessary to maintain the tissue specific cellular differentiation status and ECM production in adult human tendons and ligaments. PMID:23686683

Nakahara, Hiroyuki; Hasegawa, Akihiko; Otabe, Koji; Ayabe, Fumiaki; Matsukawa, Tetsuya; Onizuka, Naoko; Ito, Yoshiaki; Ozaki, Toshifumi; Lotz, Martin K.; Asahara, Hiroshi

2013-01-01

347

In vitro characterization of self-assembled anterior cruciate ligament cell spheroids for ligament tissue engineering.  

PubMed

Tissue engineering of an anterior cruciate ligament (ACL) implant with functional enthesis requires site-directed seeding of different cell types on the same scaffold. Therefore, we studied the suitability of self-assembled three-dimensional spheroids generated by lapine ACL ligament fibroblasts for directed scaffold colonization. The spheroids were characterized in vitro during 14 days in static and 7 days in dynamic culture. Size maintenance of self-assembled spheroids, the vitality, the morphology and the expression pattern of the cells were monitored. Additionally, we analyzed the total sulfated glycosaminoglycan, collagen contents and the expression of the ligament components type I collagen, decorin and tenascin C on protein and for COL1A1, DCN and TNMD on gene level in the spheroids. Subsequently, the cell colonization of polylactide-co-caprolactone [P(LA-CL)] and polydioxanone (PDS) polymer scaffolds was assessed in response to a directed, spheroid-based seeding technique. ACL cells were able to self-assemble spheroids and survive over 14 days. The spheroids decreased in size but not in cellularity depending on the culture time and maintained or even increased their differentiation state. The area of P[LA-CL] scaffolds, colonized after 14 days by the cells of one spheroid, was in average 4.57 ± 2.3 mm(2). Scaffolds consisting of the polymer P[LA-CL] were more suitable for colonization by spheroids than PDS embroideries. We conclude that ACL cell spheroids are suitable as site-directed seeding strategy for scaffolds in ACL tissue engineering approaches and recommend the use of freshly assembled spheroids for scaffold colonization, due to their balanced proliferation and differentiation. PMID:25256666

Hoyer, M; Meier, C; Breier, A; Hahner, J; Heinrich, G; Drechsel, N; Meyer, M; Rentsch, C; Garbe, L-A; Ertel, W; Lohan, A; Schulze-Tanzil, G

2015-03-01

348

Mesenchymal stem cell characteristics of human anterior cruciate ligament outgrowth cells.  

PubMed

When ruptured, the anterior cruciate ligament (ACL) of the human knee has limited regenerative potential. However, the goal of this report was to show that the cells that migrate out of the human ACL constitute a rich population of progenitor cells and we hypothesize that they display mesenchymal stem cell (MSC) characteristics when compared with adherent cells derived from bone marrow or collagenase digests from ACL. We show that ACL outgrowth cells are adherent, fibroblastic cells with a surface immunophenotype strongly positive for cluster of differentiation (CD)29, CD44, CD49c, CD73, CD90, CD97, CD105, CD146, and CD166, weakly positive for CD106 and CD14, but negative for CD11c, CD31, CD34, CD40, CD45, CD53, CD74, CD133, CD144, and CD163. Staining for STRO-1 was seen by immunohistochemistry but not flow cytometry. Under suitable culture conditions, the ACL outgrowth-derived MSCs differentiated into chondrocytes, osteoblasts, and adipocytes and showed capacity to self-renew in an in vitro assay of ligamentogenesis. MSCs derived from collagenase digests of ACL tissue and human bone marrow were analyzed in parallel and displayed similar, but not identical, properties. In situ staining of the ACL suggests that the MSCs reside both aligned with the collagenous matrix of the ligament and adjacent to small blood vessels. We conclude that the cells that emigrate from damaged ACLs are MSCs and that they have the potential to provide the basis for a superior, biological repair of this ligament. PMID:21247268

Steinert, Andre F; Kunz, Manuela; Prager, Patrick; Barthel, Thomas; Jakob, Franz; Nöth, Ulrich; Murray, Martha M; Evans, Christopher H; Porter, Ryan M

2011-05-01

349

Isolation and characterization of human anterior cruciate ligament-derived vascular stem cells.  

PubMed

The anterior cruciate ligament (ACL) usually fails to heal after rupture mainly due to the inability of the cells within the ACL tissue to establish an adequate healing process, making graft reconstruction surgery a necessity. However, some reports have shown that there is a healing potential of ACL with primary suture repair. Although some reports showed the existence of mesenchymal stem cell-like cells in human ACL tissues, their origin still remains unclear. Recently, blood vessels have been reported to represent a rich supply of stem/progenitor cells with a characteristic expression of CD34 and CD146. In this study, we attempted to validate the hypothesis that CD34- and CD146-expressing vascular cells exist in hACL tissues, have a potential for multi-lineage differentiation, and are recruited to the rupture site to participate in the intrinsic healing of injured ACL. Immunohistochemistry and flow cytometry analysis of hACL tissues demonstrated that it contains significantly more CD34 and CD146-positive cells in the ACL ruptured site compared with the noninjured midsubstance. CD34+CD45- cells isolated from ACL ruptured site showed higher expansionary potentials than CD146+CD45- and CD34-CD146-CD45- cells, and displayed higher differentiation potentials into osteogenic, adipogenic, and angiogenic lineages than the other cell populations. Immunohistochemistry of fetal and adult hACL tissues demonstrated a higher number of CD34 and CD146-positive cells in the ACL septum region compared with the midsubstance. In conclusion, our findings suggest that the ACL septum region contains a population of vascular-derived stem cells that may contribute to ligament regeneration and repair at the site of rupture. PMID:21732814

Matsumoto, Tomoyuki; Ingham, Sheila M; Mifune, Yutaka; Osawa, Aki; Logar, Alison; Usas, Arvydas; Kuroda, Ryosuke; Kurosaka, Masahiro; Fu, Freddie H; Huard, Johnny

2012-04-10

350

Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors  

PubMed Central

AIM: To evaluate the effect of the application of plasma rich in growth factors (PRGF)-Endoret to the remaining intact bundle in partial anterior cruciate ligament (ACL) tears. METHODS: A retrospective review of the rate of return to play in football players treated with the application of PRGF-Endoret in the remaining intact bundle in partial ACL injuries that underwent surgery for knee instability. Patients with knee instability requiring revision surgery for remnant ACL were selected. PRGF was applied in the wider part of posterolateral bundle and the time it took patients to return to their full sporting activities at the same level before the injury was evaluated. RESULTS: A total of 19 patients were reviewed. Three had a Tegner activity level of 10 and the remaining 16 level 9. The time between the injury and the time of surgery was 5.78 wk (SD 1.57). In total, 81.75% (16/19) returned to the same pre-injury level of sport activity (Tegner 9-10). 17 males and 2 females were treated. The rate of associated injury was 68.42% meniscal lesions and 26.31% cartilage lesions. The KT-1000 values were normalized in all operated cases. One patient was not able to return to sport due to the extent of their cartilage lesions. The 15 patients with Tegner activity level 9 returned to play at an average of 16.20 wk (SD 1.44) while the 3 patients with Tegner activity level 10 did so in 12.33 wk (SD 1.11). CONCLUSION: With one remaining intact bundle the application of PRGF-Endoret in instability cases due to partial ACL tear showed high return to sport rates at pre- injury level in professional football players. PMID:25035842

Seijas, Roberto; Ares, Oscar; Cuscó, Xavier; Álvarez, Pedro; Steinbacher, Gilbert; Cugat, Ramón

2014-01-01

351

Effect of donor age on the proportion of mesenchymal stem cells derived from anterior cruciate ligaments.  

PubMed

The characteristics of anterior cruciate ligament (ACL)-derived mesenchymal stem cells (MSCs), such as proportion and multilineage potential, can be affected by donor age. However, the qualitative and quantitative features of ACL MSCs isolated from younger and older individuals have not yet been compared directly. This study assessed the phenotypic and functional differences in ACL-MSCs isolated from younger and older donors and evaluated the correlation between ACL-MSC proportion and donor age. Torn ACL remnants were harvested from 36 patients undergoing ACL reconstruction (young: 29.67 ± 10.92 years) and 33 undergoing TKA (old: 67.96 ± 5.22 years) and the proportion of their MSCs were measured. The mean proportion of MSCs was slightly higher in older ACL samples of the TKA group than of the younger ACL reconstruction group (19.69 ± 8.57% vs. 15.33 ± 7.49%, p = 0.024), but the proportions of MSCs at passages 1 and 2 were similar. MSCs from both groups possessed comparable multilineage potentiality, as they could be differentiated into adipocytes, osteocytes, and chondrocytes at similar level. No significant correlations were observed between patient age and MSC proportions at passages 0-2 or between age and MSC proportion in both the ACL reconstruction and TKA groups. Multiple linear regression analysis found no significant predictor of MSC proportion including donor age for each passage. Microarray analysis identified several genes that were differentially regulated in ACL-MSCs from old TKA patients compared to young ACL reconstruction patients. Genes of interest encode components of the extracellular matrix (ECM) and may thus play a crucial role in modulating tissue homeostasis, remodeling, and repair in response to damage or disease. In conclusion, the proportion of freshly isolated ACL-MSC was higher in elderly TKA patients than in younger patients with ACL tears, but their phenotypic and multilineage potential were comparable. PMID:25729860

Lee, Dae-Hee; Ng, Joanne; Kim, Sang-Beom; Sonn, Chung Hee; Lee, Kyung-Mi; Han, Seung-Beom

2015-01-01

352

Peripheral nerve blockade as an exclusive approach to obturator nerve block in anterior cruciate ligament reconstructive surgery  

PubMed Central

Background Obturator nerve block plays an additive role on the quality of analgesia for knee surgery. Since the use of dual guidance increases the success rate of nerve blocks, we investigated the feasibility of performing anterior cruciate ligament reconstruction under dual-guided blockade of obturator with femoral and sciatic nerves. Furthermore, we propose a novel method for the assessment of obturator nerve block. Methods Fifty-seven patients undergoing anterior cruciate ligament repair were studied. Neurostimulating needles were guided out-of-plane by ultrasound. To induce the obturator nerve block, 10 ml of ropivacaine 0.5% were injected after eliciting contractions of adductor longus, brevis and magnus followed by block assessment for 30 minutes by examining the patient lift and left down the leg. Results The sonographic recognition of obturator nerve was easy and quick in all cases. Time for applying the block was 119.9 ± 79.2 sec. Assessing this block with lifting-leaving down the leg gave satisfactory results in 24.0 ± 5.07 min. After performing femoral-sciatic blocks, the inflation of tourniquet resulted in VAS score of > 0 in 2/57 patients and operation in 12/57. Total dose of fentanyl was 120.1 ± 64.6 µg and of midazolam 1.86 ± 0.8 mg. In 6 patients propofol was administered for sedation and 1 of them required ventilation with laryngeal mask airway, converting the anesthesia technique to general anesthesia. Conclusions Our data suggest that anterior cruciate ligament reconstruction can be performed under obturator-femoral-sciatic blocks. Identification of obturator nerve with ultrasound is easy and the block can be assessed by observing how the patient lifts and leaves down the leg. PMID:24363843

Simeoforidou, Marina; Basdekis, George; Tsiaka, Katerina; Chantzi, Eleni; Vretzakis, George

2013-01-01

353

Bioresorbable scaffolds for anterior cruciate ligament reconstruction: do we need an off-the-shelf ACL substitute?  

PubMed

Currently available anterior cruciate ligament (ACL) graft sources, autograft and allograft, present potential problems that a natural biomaterial ACL graft might be able to solve. Earlier efforts in the development of synthetic ACL grafts were less than optimal, and those devices have largely been abandoned. We can learn from these past failures, and potentially develop a bioresorbable scaffold for ACL reconstruction, which will provide immediate stability, promote and direct tissue in growth, and degrade at an appropriate rate, without harmful wear debris. We have developed a modified silk scaffold, which is currently being evaluated in humans in a pilot study. PMID:20160629

Richmond, John C; Weitzel, Paul P

2010-03-01

354

A tissue engineering approach to anterior cruciate ligament regeneration using novel shaped capillary channel polymer fibers  

NASA Astrophysics Data System (ADS)

Ruptures of the anterior cruciate ligament (ACL) are the most frequent of injuries to the knee due to its role in preventing anterior translation of the tibia. It is estimated that as many as 200,000 Americans per year will suffer from a ruptured ACL, resulting in management costs on the order of 5 billion dollars. Without treatment these patients are unable to return to normal activity, as a consequence of the joint instability found within the ACL deficient knee. Over the last thirty years, a variety of non-degradable, synthetic fibers have been evaluated for their use in ACL reconstruction; however, a widely accepted prosthesis has been unattainable due to differences in mechanical properties of the synthetic graft relative to the native tissue. Tissue engineering is an interdisciplinary field charged with the task of developing therapeutic solutions for tissue and organ failure by enhancing the natural wound healing process through the use of cellular transplants, biomaterials, and the delivery of bioactive molecules. The capillary channel polymer (CC-P) fibers used in this research were fabricated by melt extrusion from polyethylene terephthalate and polybutylene terephthalate. These fibers possess aligned micrometer scale surface channels that may serve as physical templates for tissue growth and regeneration. This inherent surface topography offers a unique and industrially viable approach for cellular contact guidance on three dimensional constructs. In this fundamental research the ability of these fiber channels to support the adhesion, alignment, and organization of fibroblasts was demonstrated and found to be superior to round fiber controls. The results demonstrated greater uniformity of seeding and accelerated formation of multi-layered three-dimensional biomass for the CC-P fibers relative to those with a circular cross-section. Furthermore, the CC-P geometry induced nuclear elongation consistent with that observed in native ACL tissue. Through the application of uniaxial cyclic strain the mechanical properties of the cell seeded CC-P fiber scaffold systems were shown to improve via the induction of increased cellular proliferation and extracellular matrix synthesis. Finally, unlike many studies examining the effects of cyclic strain on cellular behavior, the CC-P fiber geometry displayed the ability to maintain cellular alignment in the presence of an applied uniaxial cyclic strain.

Sinclair, Kristofer D.

2009-12-01

355

Changes in quadriceps and hamstring cocontraction following landing instruction in patients with anterior cruciate ligament reconstruction.  

PubMed

Study Design Pretest/posttest controlled laboratory study. Objectives To determine changes in the neuromuscular activation of the quadriceps and hamstrings following instructions aimed at improving knee flexion during a single-limb landing task in persons who have undergone anterior cruciate ligament reconstruction (ACLR). Background Clinicians advise patients who have undergone ACLR to increase knee flexion during landing tasks to improve impact attenuation. Another long-standing construct underlying such instruction involves increasing cocontraction of the hamstrings with the quadriceps to limit anterior shear of the tibia on the femur. The current study examined whether cocontraction of the knee musculature changes following instruction to increase knee flexion during landing. Methods Thirty-four physically active subjects with unilateral ACLR participated in a 1-time testing session. The kinetics and kinematics of single-leg landing on the surgical limb were analyzed before and after instruction to increase knee flexion and reduce the impact of landing. Vastus lateralis and biceps femoris activities were analyzed using surface electromyography and normalized to a maximal voluntary isometric contraction (MVIC). Cocontraction indices were integrated over the weight-acceptance phase of landing. Results Following instruction, peak knee flexion increased (preinstruction mean ± SD, 56° ± 11°; postinstruction, 77° ± 12°; P<.001) and peak vertical ground reaction forces decreased (preinstruction, 3.50 ± 0.42 body mass; postinstruction, 3.06 ± 0.44 body mass; P<.001). Cocontraction also decreased following instruction (preinstruction, 30.88% ± 17.68% MVIC; postinstruction, 23.74% ± 15.39% MVIC; P<.001). The change in cocontraction was correlated with a decrease in hamstring activity (preinstruction, 23.79% ± 12.88% MVIC; postinstruction, 19.72% ± 13.92% MVIC; r = 0.80; P<.001). Conclusion Landing instruction produced both a statistically and clinically significant change in landing mechanics in persons post-ACLR. Conscious improvement of the absorptive power of the surgical limb was marked by decreased hamstring activity and cocontraction during single-limb landing. J Orthop Sports Phys Ther 2015;45(4):273-280. Epub 13 Feb 2015. doi:10.2519/jospt.2015.5335. PMID:25679342

Elias, Audrey R C; Hammill, Curt D; Mizner, Ryan L

2015-04-01

356

Arthroscopic Double-Row Anterior Stabilization and Bankart Repair for the “High-Risk” Athlete  

PubMed Central

In addition to operative intervention for the patient with recurrent shoulder instability, current literature suggests that younger athletic patients unwilling to modify their activities may benefit from an early surgical shoulder stabilization procedure. Although open shoulder stabilization clearly has a role to play in some cases, we believe that further optimization of arthroscopic fixation techniques may allow us to continue to refine the indications for open stabilization. In particular, when an arthroscopic approach is used for capsulolabral repair in relatively high-risk groups, it may be beneficial to use a double-row repair technique. We describe our technique for shoulder stabilization through double-row capsulolabral repair of a soft-tissue Bankart lesion in the high-risk patient with shoulder instability or the patient with a small osseous Bankart lesion. PMID:24749044

Moran, Cathal J.; Fabricant, Peter D.; Kang, Richard; Cordasco, Frank A.

2014-01-01

357

Chronic instability of the anterior tibiofibular syndesmosis of the ankle. Arthroscopic findings and results of anatomical reconstruction  

PubMed Central

Background The arthroscopic findings in patients with chronic anterior syndesmotic instability that need reconstructive surgery have never been described extensively. Methods In 12 patients the clinical suspicion of chronic instability of the syndesmosis was confirmed during arthroscopy of the ankle. All findings during the arthroscopy were scored. Anatomical reconstruction of the anterior tibiofibular syndesmosis was performed in all patients. The AOFAS score was assessed to evaluate the result of the reconstruction. At an average of 43 months after the reconstruction all patients were seen for follow-up. Results The syndesmosis being easily accessible for the 3 mm transverse end of probe which could be rotated around its longitudinal axis in all cases during arthroscopy of the ankle joint, confirmed the diagnosis. Cartilage damage was seen in 8 ankles, of which in 7 patients the damage was situated at the medial side of the ankle joint. The intraarticular part of anterior tibiofibular ligament was visibly damaged in 5 patients. Synovitis was seen in all but one ankle joint. After surgical reconstruction the AOFAS score improved from an average of 72 pre-operatively to 92 post-operatively. Conclusions To confirm the clinical suspicion, the final diagnosis of chronic instability of the anterior syndesmosis can be made during arthroscopy of the ankle. Cartilage damage to the medial side of the tibiotalar joint is often seen and might be the result of syndesmotic instability. Good results are achieved by anatomic reconstruction of the anterior syndesmosis, and all patients in this study would undergo the surgery again if necessary. PMID:21951619

2011-01-01

358

Is patellofemoral joint osteoarthritis an under-recognised outcome of anterior cruciate ligament reconstruction? A narrative literature review.  

PubMed

Patellofemoral joint (PFJ) osteoarthritis (OA) is a prevalent disease capable of being a potent source of knee symptoms. Although anterior cruciate ligament (ACL) injury and reconstruction (ACLR) are well-established risk factors for the development of tibiofemoral joint OA, PFJ OA after ACL reconstruction has gone largely unrecognised. This is despite the high prevalence of anterior knee pain after ACLR, which can reduce the capacity for physical activity and quality of life. The susceptibility of the PFJ to degenerative change after ACLR may have implications for current rehabilitation strategies. This review summarises the evidence describing the prevalence of PFJ OA after ACLR and examines why this compartment may be at increased risk of early onset OA after ACLR. Strategies that address the modifiable factors for risk of PFJ OA may aid in alleviating joint loads and symptoms for people after ACLR. PMID:23038783

Culvenor, Adam G; Cook, Jill L; Collins, Natalie J; Crossley, Kay M

2013-01-01

359

Pediatric Anterior Cruciate Ligament Femoral Fixation: The Trans-Iliotibial Band Endoscopic Portal for Direct Visualization of Ideal Button Placement  

PubMed Central

Pediatric and adolescent anterior cruciate ligament reconstruction is a commonly performed procedure that has been increasing in incidence. Multiple techniques for graft fixation have been described. Button-based femoral cortical suspension fixation of the anterior cruciate ligament graft allows for fast, secure fixation with strong load-to-failure biomechanical properties. The biomechanical properties of button-based femoral cortical suspension fixation are especially beneficial with soft-tissue grafts such as hamstring autografts. Confirmation of a successfully flipped button can be achieved with intraoperative fluoroscopy or indirect viewing; however, these techniques do not provide direct visualization of the flipped button. Our trans-iliotibial band endoscopic portal allows the surgeon to safely and directly visualize the flipped button on the lateral femoral cortex and ensure that there is no malpositioning in the form of an incompletely flipped button or from soft-tissue interposition between the button and the lateral femoral cortex. This portal therefore allows for direct visual confirmation that the button is fully flipped and resting flush against the femoral cortex, deep to the iliotibial band and vastus lateralis. PMID:25126498

Mistovich, R. Justin; O'Toole, Patrick O.J.; Ganley, Theodore J.

2014-01-01

360

Avoiding Graft-Tunnel Length Mismatch in Anterior Cruciate Ligament Reconstruction: The Single–Bone Plug Technique  

PubMed Central

Anterior cruciate ligament reconstruction, using autogenous bone–patellar tendon–bone (BTB) as a graft material, is commonly performed in the setting of anterior cruciate ligament insufficiency. Although bone–patellar tendon–bone autograft has an extensive track record, showing excellent clinical results, donor-site morbidity and graft-tunnel mismatch can still be problematic for a subset of patients. In the setting of a tendon graft that is too long, adequate interference screw fixation cannot be obtained, typically resulting in a tibial-sided bone plug that achieves less than 15 to 20 mm of bone in the distal tibial tunnel. We present an easy and effective technique for avoiding the graft-tunnel mismatch problems that commonly occur in patients who have an excessively long patellar tendons. This technique involves a simple preoperative planning algorithm that ultimately results in a single tibial-sided plug harvest. Bony interference fixation is then obtained on the femoral side and soft-tissue fixation on the tibial side. This technique allows for satisfactory graft fixation while avoiding the donor-site morbidity associated with patellar bone plug harvest. PMID:25126515

Grawe, Brian; Smerina, Amber; Allen, Answorth

2014-01-01

361

Graft selection for anterior cruciate ligament reconstruction: a level I systematic review comparing failure rates and functional outcomes.  

PubMed

Tear of the anterior cruciate ligament (ACL) is the most common ligamentous injury of the knee. Reconstructing this ligament is often required to restore functional stability of the knee. Many graft options are available for ACL reconstruction, including different autograft and allograft tissues. Autografts include bone-patellar tendon-bone composites (PT), combined semitendinosus and gracilis hamstring tendons (HT), and quadriceps tendon. Allograft options include the same types of tendons harvested from donors, in addition to Achilles and tibialis tendons. Tissue-engineered anterior cruciate grafts are not yet available for clinical use, but may become a feasible alternative in the future. The purpose of this systematic review is to assess whether one of the popular grafts (PT and HT) is preferable for reconstructing the ACL. For this objective, the authors selected only true level I studies that compared these graft choices in functional clinical outcomes, failure rates, and other objective parameters following reconstruction of the ACL. In addition, this review discusses mechanical considerations related to different allograft tissues. PMID:20399364

Reinhardt, Keith R; Hetsroni, Iftach; Marx, Robert G

2010-04-01

362

The efficacy of combined cryotherapy and compression compared with cryotherapy alone following anterior cruciate ligament reconstruction.  

PubMed

While cryotherapy has been shown to decrease postoperative pain after anterior cruciate ligament (ACL) reconstruction, less is known of the effects of combined cryotherapy and compression. The goal of this study was to compare subjective and objective patient outcomes following ACL reconstruction with combined compression and cryotherapy compared with traditional ice therapy alone. Patients undergoing ACL reconstruction were randomized to cryotherapy/compression device (group 1) or a standardized ice pack (group 2). Both groups were instructed to use the ice or cryotherapy/compression device three times per day and return to the clinic at 1, 2, and 6 weeks postoperatively. Patient-derived outcome measurements used in this study consisted of the visual analog scale (VAS), the Lysholm knee score, Short Form-36 (SF-36), and single assessment numerical evaluation (SANE). Circumferential measurements of the knee at three locations (1 cm proximal to patella, mid-patella, and 1 cm distal to patella) were also obtained as a measure of postoperative edema. Narcotic medication use was recorded by questionnaire. The primary outcome measure (VAS) was significantly different among groups in the preoperative measurement, despite similarities in group demographics. Baseline VAS for group 1 was 54.9 compared with group 2 at 35.6 (p = 0.01). By 6 weeks, this had lowered to 28.1 and 40.3, respectively, resulting in a significant 27-point decrease in mean VAS for group 1 (p < 0.0001). However, the small increase in VAS for group 2 was not significant (p = 0.34). No significant differences were noted for the Lysholm, SF-36, or SANE scores either between groups or time points. Furthermore, no significant differences were noted for any of the circumferential measurements either between groups or time points. Of all patients, 83% of group 1 discontinued narcotic use by 6 weeks, compared with only 28% of group 2 (p = 0.0008). The use of combined cryotherapy and compression in the postoperative period after ACL reconstruction results in improved, short-term pain relief and a greater likelihood of independence from narcotic use compared with cryotherapy alone. PMID:22928433

Waterman, Brian; Walker, John J; Swaims, Chad; Shortt, Michael; Todd, Michael S; Machen, Shaun M; Owens, Brett D

2012-05-01

363

Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction  

PubMed Central

Ligament reconstruction is the current standard of care for active patients with an anterior cruciate ligament (ACL) rupture. Although the majority of ACL reconstruction (ACLR) surgeries successfully restore the mechanical stability of the injured knee, postsurgical outcomes remain widely varied. Less than half of athletes who undergo ACLR return to sport within the first year after surgery, and it is estimated that approximately 1 in 4 to 1 in 5 young, active athletes who undergo ACLR will go on to a second knee injury. The outcomes after a second knee injury and surgery are significantly less favorable than outcomes after primary injuries. As advances in graft reconstruction and fixation techniques have improved to consistently restore passive joint stability to the preinjury level, successful return to sport after ACLR appears to be predicated on numerous postsurgical factors. Importantly, a secondary ACL injury is most strongly related to modifiable postsurgical risk factors. Biomechanical abnormalities and movement asymmetries, which are more prevalent in this cohort than previously hypothesized, can persist despite high levels of functional performance, and also represent biomechanical and neuromuscular control deficits and imbalances that are strongly associated with secondary injury incidence. Decreased neuromuscular control and high-risk movement biomechanics, which appear to be heavily influenced by abnormal trunk and lower extremity movement patterns, not only predict first knee injury risk but also reinjury risk. These seminal findings indicate that abnormal movement biomechanics and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. Evidence-based medicine (EBM) strategies should be used to develop effective, efficacious interventions targeted to these impairments to optimize the safe return to high-risk activity. In this Current Concepts article, the authors present the latest evidence related to risk factors associated with ligament failure or a secondary (contralateral) injury in athletes who return to sport after ACLR. From these data, they propose an EBM paradigm shift in postoperative rehabilitation and return-to-sport training after ACLR that is focused on the resolution of neuromuscular deficits that commonly persist after surgical reconstruction and standard rehabilitation of athletes. PMID:23041233

Hewett, Timothy E.; Di Stasi, Stephanie L.; Myer, Gregory D.

2013-01-01

364

Surgical treatment of partial anterior cruciate ligament lesions: medium-term results  

PubMed Central

Purpose this study was conducted to evaluate subjective and objective clinical outcomes of partial reconstruction of the anterior cruciate ligament (ACL) in comparison with complete ACL reconstruction. Methods three groups, each comprising 20 patients, were evaluated at a minimum follow-up of 12 months. The group 1 patients underwent partial ACL reconstruction, while those in group 2 and group 3 underwent complete ACL reconstruction, performed using either bone-patellar tendon-bone (BPTB) or quadrupled hamstring tendon (HT) grafts, respectively. The subjective outcome was evaluated using the Lysholm knee scale and the subjective International Knee Documentation Committee (IKDC) scoring system. A visual analog scale (VAS) was used for pain assessment and sporting activity was rated using the Tegner activity scale. Objective evaluation was performed using the IKDC objective form, KT-1000 arthrometer and KiRA triaxial accelerometer. Results at the follow-up evaluation, the mean subjective IKDC score was 86.1±10.3 in group 1, 85.2±11.1 in group 2, and 82.7±7.8 in group 3. The Lysholm score was 91.3±7.3 in group 1, 91.7±9.6 in group 2, and 89.4±6.1 in group 3. KT-1000 tests showed a mean side-to-side difference of 1.1 mm ± 1.5 mm (range, 0–5 mm) in group 1; 0.79 mm ± 0.8 mm (range, 0–2mm) in group 2; and 1.45 mm ± 1 mm (range, 0–3 mm) in group 3. The differences between groups were not statistically significant. Conclusions both subjective and objective outcomes of partial ACL reconstruction were comparable to those of complete reconstruction, but partial reconstruction in the presence of a partial lesion of the ACL is considered by the authors to be more respectful of the native vascularization, innervation and anatomy of the ACL, conferring an advantage in terms of recovery of the complete function of the knee. Level of evidence Level III, retrospective comparative study. PMID:25750906

BERRUTO, MASSIMO; GALA, LUCA; FERRUA, PAOLO; UBOLDI, FRANCESCO; FERRARA, FABRIZIO; PASQUALOTTO, STEFANO; MARELLI, BRUNO M.

2014-01-01

365

The effect of the shoe-surface interface in the development of anterior cruciate ligament strain.  

PubMed

The shoe-surface interface has been implicated as a possible risk factor for anterior cruciate ligament (ACL) injuries. The purpose of this study is to develop a biomechanical, cadaveric model to evaluate the effect of various shoe-surface interfaces on ACL strain. There will be a significant difference in ACL strain between different shoe-surface combinations when a standardized rotational moment (a simulated cutting movement) is applied to an axially loaded lower extremity. The study design was a controlled laboratory study. Eight fresh-frozen cadaveric lower extremities were thawed and the femurs were potted with the knee in 30 deg of flexion. Each specimen was placed in a custom-made testing apparatus, which allowed axial loading and tibial rotation but prevented femoral rotation. For each specimen, a 500 N axial load and a 1.5 Nm internal rotation moment were placed for four different shoe-surface combinations: group I (AstroTurf-turf shoes), group II (modern playing turf-turf shoes), group III (modern playing turf-cleats), and group IV (natural grass-cleats). Maximum strain, initial axial force and moment, and maximum axial force and moment were calculated by a strain gauge and a six component force plate. The preliminary trials confirmed a linear relationship between strain and both the moment and the axial force for our testing configuration. In the experimental trials, the average maximum strain was 3.90, 3.19, 3.14, and 2.16 for groups I-IV, respectively. Group IV had significantly less maximum strain (p<0.05) than each of the other groups. This model can reproducibly create a detectable strain in the anteromedial bundle of the ACL in response to a given axial load and internal rotation moment. Within the elastic range of the stress-strain curve, the natural grass and cleat combination produced less strain in the ACL than the other combinations. The favorable biomechanical properties of the cleat-grass interface may result in fewer noncontact ACL injuries. PMID:20524741

Drakos, Mark C; Hillstrom, Howard; Voos, James E; Miller, Anna N; Kraszewski, Andrew P; Wickiewicz, Thomas L; Warren, Russell F; Allen, Answorth A; O'Brien, Stephen J

2010-01-01

366

A meta-analysis of stability of autografts compared to allografts after anterior cruciate ligament reconstruction.  

PubMed

Allografts have recently become increasingly popular for anterior cruciate ligament reconstruction (ACLR) in the United States even though many studies have shown high allograft failure rates (Gorschewsky et al. in Am J Sports Med 33:1202, 2005; Pritchard et al. in Am J Sports Med 23:593, 2005; Roberts et al. in Am J Sports Med 19:35, 2006) and no meta-analysis or systematic review of allograft clinical stability rates in comparison to autog rafts has previously been performed. We hypothesized that allografts would demonstrate overall lower objective stability rates compared to autografts. To test this hypothesis we performed a meta-analysis of autograft and allograft stability data. A pubmed literature search of all allograft series in humans published in English was performed. Articles were then bibliographically cross-referenced to identify additional studies. Series inclusion criteria were arthrometric follow-up data using at least 30 lb or maximum manual force, stratified presentation of stability data and minimum two-year follow-up. Twenty allograft series were thus selected and compared to a previously published data set of all BPTB and Hamstring (HS) autograft ACLR series using the same study inclusion criteria and analytic and statistical methodology. IKDC standards of 0-2 mm (normal) and >5 mm (abnormal) side-to-side differences were adopted to compare studies. Normal stability for all autografts was 72 versus 59% for all allografts (P < 0.01). Abnormal stability was 5% for all autografts versus 14% for all allografts (P < 0.01). Bone-patellar-tendon-bone (BPTB) autograft normal stability was 66% versus 57% for BPTB allografts (P < 0.01). Abnormal BPTB autograft stability was 6 versus 16% for BPTB allograft. Hamstring autograft normal or abnormal stability rates were 77% and 4% and were compared to soft tissue allografts as a group which were 64% and 12% (P < 0.01). This is the first meta-analysis comparing autograft to allograft stability in ACLR. Allografts had significantly lower normal stability rates than autografts. The allograft abnormal stability rate, which usually represents graft failure, was significantly higher than that of autografts: nearly three times greater. It would therefore appear that autografts are the graft of choice for routine ACLR with allografts better reserved for multiple ligament-injured knees where extra tissue may be required. PMID:17437083

Prodromos, Chadwick; Joyce, Brian; Shi, Kelvin

2007-07-01

367

Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players  

PubMed Central

Background: Anterior cruciate ligament (ACL) rupture is a significant injury in National Basketball Association (NBA) players. Hypotheses: NBA players undergoing ACL reconstruction (ACLR) have high rates of return to sport (RTS), with RTS the season following surgery, no difference in performance between pre- and postsurgery, and no difference in RTS rate or performance between cases (ACLR) and controls (no ACL tear). Study Design: Case-control. Methods: NBA players undergoing ACLR were evaluated. Matched controls for age, body mass index (BMI), position, and NBA experience were selected during the same years as those undergoing ACLR. RTS and performance were compared between cases and controls. Paired-sample Student t tests, chi-square, and linear regression analyses were performed for comparison of within- and between-group variables. Results: Fifty-eight NBA players underwent ACLR while in the NBA. Mean player age was 25.7 ± 3.5 years. Forty percent of ACL tears occurred in the fourth quarter. Fifty players (86%) RTS in the NBA, and 7 players (12%) RTS in the International Basketball Federation (FIBA) or D-league. Ninety-eight percent of players RTS in the NBA the season following ACLR (11.6 ± 4.1 months from injury). Two players (3.1%) required revision ACLR. Career length following ACLR was 4.3 ± 3.4 years. Performance upon RTS following surgery declined significantly (P < 0.05) regarding games per season; minutes, points, and rebounds per game; and field goal percentage. However, following the index year, controls’ performances declined significantly in games per season; points, rebounds, assists, blocks, and steals per game; and field goal and free throw percentage. Other than games per season, there was no significant difference between cases and controls. Conclusion: There is a high RTS rate in the NBA following ACLR. Nearly all players RTS the season following surgery. Performance significantly declined from preinjury level; however, this was not significantly different from controls. ACL re-tear rate was low. Clinical Relevance: There is a high RTS rate in the NBA after ACLR, with no difference in performance upon RTS compared with controls. PMID:24427434

Harris, Joshua D.; Erickson, Brandon J.; Bach, Bernard R.; Abrams, Geoffrey D.; Cvetanovich, Gregory L.; Forsythe, Brian; McCormick, Frank M.; Gupta, Anil K.; Cole, Brian J.

2013-01-01

368

Interactions between collagen gene variants and risk of anterior cruciate ligament rupture.  

PubMed

The COL5A1 and COL12A1 variants are independently associated with modulating the risk of anterior cruciate ligament (ACL) rupture in females. The objective of this study was to further investigate if COL3A1 and COL6A1 variants independently, as well as, collagen gene-gene interactions, modulate ACL rupture risk. Three hundred and thirty-three South African (SA, n = 242) and Polish (PL, n = 91) participants with diagnosed ACL ruptures and 378 controls (235 SA and 143 PL) were recruited. Participants were genotyped for COL3A1 rs1800255 G/A, COL5A1 rs12722 (T/C), COL6A1 rs35796750 (T/C) and COL12A1 rs970547 (A/G). No significant associations were identified between COL6A1 rs35796750 and COL3A1 rs1800255 genotypes and risk of ACL rupture in the SA cohort. The COL3A1 AA genotype was, however, significantly (p = 0.036) over-represented in the PL ACL group (9.9%, n = 9) when compared to the PL control (CON) group (2.8%, n = 4). Although there were genotype distribution differences between the SA and PL cohorts, the T+A-inferred pseudo-haplotype constructed from COL5A1 and COL12A1 was significantly over-represented in the female ACL group when compared to the female CON group within the SA (T+A ACL 50.5%, T+A CON 38.1%, p = 0.022), PL (T+A ACL 56.3%, T+A CON 36.3%, p = 0.029) and combined (T+A ACL 51.8%, T+A CON 37.5%, p = 0.004) cohorts. In conclusion, the novel main finding of this study was a significant interaction between the COL5A1 rs12722 T/C and COL12A1 rs970547 A/G variants and risk of ACL injury. These results highlight the importance of investigating gene-gene interactions in the aetiology of ACL ruptures in multiple independent cohorts. PMID:25073002

O'Connell, Kevin; Knight, Hayley; Ficek, Krzysztof; Leonska-Duniec, Agata; Maciejewska-Karlowska, Agnieszka; Sawczuk, Marek; Stepien-Slodkowska, Marta; O'Cuinneagain, Dion; van der Merwe, Willem; Posthumus, Michael; Cieszczyk, Pawel; Collins, Malcolm

2015-06-01

369

Mesenchymal stem cells and collagen patches for anterior cruciate ligament repair  

PubMed Central

AIM: To investigate collagen patches seeded with mesenchymal stem cells (MSCs) and/or tenocytes (TCs) with regards to their suitability for anterior cruciate ligament (ACL) repair. METHODS: Dynamic intraligamentary stabilization utilizes a dynamic screw system to keep ACL remnants in place and promote biological healing, supplemented by collagen patches. How these scaffolds interact with cells and what type of benefit they provide has not yet been investigated in detail. Primary ACL-derived TCs and human bone marrow derived MSCs were seeded onto two different types of 3D collagen scaffolds, Chondro-Gide® (CG) and Novocart® (NC). Cells were seeded onto the scaffolds and cultured for 7 d either as a pure populations or as “premix” containing a 1:1 ratio of TCs to MSCs. Additionally, as controls, cells were seeded in monolayers and in co-cultures on both sides of porous high-density membrane inserts (0.4 ?m). We analyzed the patches by real time polymerase chain reaction, glycosaminoglycan (GAG), DNA and hydroxy-proline (HYP) content. To determine cell spreading and adherence in the scaffolds microscopic imaging techniques, i.e., confocal laser scanning microscopy (cLSM) and scanning electron microscopy (SEM), were applied. RESULTS: CLSM and SEM imaging analysis confirmed cell adherence onto scaffolds. The metabolic cell activity revealed that patches promote adherence and proliferation of cells. The most dramatic increase in absolute metabolic cell activity was measured for CG samples seeded with tenocytes or a 1:1 cell premix. Analysis of DNA content and cLSM imaging also indicated MSCs were not proliferating as nicely as tenocytes on CG. The HYP to GAG ratio significantly changed for the premix group, resulting from a slightly lower GAG content, demonstrating that the cells are modifying the underlying matrix. Real-time quantitative polymerase chain reaction data indicated that MSCs showed a trend of differentiation towards a more tenogenic-like phenotype after 7 d. CONCLUSION: CG and NC are both cyto-compatible with primary MSCs and TCs; TCs seemed to perform better on these collagen patches than MSCs.

Gantenbein, Benjamin; Gadhari, Neha; Chan, Samantha CW; Kohl, Sandro; Ahmad, Sufian S

2015-01-01

370

Tiludronate treatment improves structural changes and symptoms of osteoarthritis in the canine anterior cruciate ligament model  

PubMed Central

Introduction The aim of this prospective, randomized, controlled, double-blind study was to evaluate the effects of tiludronate (TLN), a bisphosphonate, on structural, biochemical and molecular changes and function in an experimental dog model of osteoarthritis (OA). Methods Baseline values were established the week preceding surgical transection of the right cranial/anterior cruciate ligament, with eight dogs serving as OA placebo controls and eight others receiving four TLN injections (2 mg/kg subcutaneously) at two-week intervals starting the day of surgery for eight weeks. At baseline, Week 4 and Week 8, the functional outcome was evaluated using kinetic gait analysis, telemetered locomotor actimetry and video-automated behaviour capture. Pain impairment was assessed using a composite numerical rating scale (NRS), a visual analog scale, and electrodermal activity (EDA). At necropsy (Week 8), macroscopic and histomorphological analyses of synovium, cartilage and subchondral bone of the femoral condyles and tibial plateaus were assessed. Immunohistochemistry of cartilage (matrix metalloproteinase (MMP)-1, MMP-13, and a disintegrin and metalloproteinase domain with thrombospondin motifs (ADAMTS5)) and subchondral bone (cathepsin K) was performed. Synovial fluid was analyzed for inflammatory (PGE2 and nitrite/nitrate levels) biomarkers. Statistical analyses (mixed and generalized linear models) were performed with an ?-threshold of 0.05. Results A better functional outcome was observed in TLN dogs than OA placebo controls. Hence, TLN dogs had lower gait disability (P = 0.04 at Week 8) and NRS score (P = 0.03, group effect), and demonstrated behaviours of painless condition with the video-capture (P < 0.04). Dogs treated with TLN demonstrated a trend toward improved actimetry and less pain according to EDA. Macroscopically, both groups had similar level of morphometric lesions, TLN-treated dogs having less joint effusion (P = 0.01), reduced synovial fluid levels of PGE2 (P = 0.02), nitrites/nitrates (P = 0.01), lower synovitis score (P < 0.01) and a greater subchondral bone surface (P < 0.01). Immunohistochemical staining revealed lower levels in TLN-treated dogs of MMP-13 (P = 0.02), ADAMTS5 (P = 0.02) in cartilage and cathepsin K (P = 0.02) in subchondral bone. Conclusion Tiludronate treatment demonstrated a positive effect on gait disability and joint symptoms. This is likely related to the positive influence of the treatment at improving some OA structural changes and reducing the synthesis of catabolic and inflammatory mediators. PMID:21693018

2011-01-01

371

The effects of levofloxacin on rabbit anterior cruciate ligament cells in vitro  

SciTech Connect

Articular cartilage, epiphyseal growth plate and tendons have been recognized as targets of fluoroquinolone-induced connective tissue toxicity. The effects of fluoroquinolones on ligament tissues are still unknown. The aim of this study was to investigate the effects of levofloxacin, a typical fluoroquinolone antibiotic drug, on rabbit anterior cruciate ligament (ACL) cells in vitro. Rabbit ACL cells were treated with levofloxacin at different concentrations (0, 14, 28, 56, 112 and 224 {mu}M) and were assessed to determine the possible cytotoxic effects of levofloxacin on ACL cells. Levofloxacin, with concentrations ranging from 28 to 224 {mu}M, induced dose-dependent ACL cell apoptosis. Characteristic markers of programmed cell death and degenerative changes were identified by electron microscopy in the ACL cells treated with 28 {mu}M of levofloxacin. Moreover, levofloxacin significantly increased the mRNA expression of matrix metalloproteinase 3 (MMP-3) and MMP-13 and decreased the expression of tissue inhibitors of metalloproteinase 1 (TIMP-1) in a concentration-dependent manner; TIMP-3 and collagen type I alpha 1 (Col1A1) mRNA expression was not affected. Immunocytochemical analysis indicated that levofloxacin markedly increased the expression of active caspase-3 within a concentration range of 28 to 224 {mu}M, whereas a clear-cut decrease in Col1A1 expression was found with levofloxacin treatment concentrations of 112 and 224 {mu}M, compared to controls. Our data suggest that levofloxacin has cytotoxic effects on ACL cells characterized by enhanced apoptosis and decreased extracellular matrix, which suggest a potential adverse effect of fluoroquinolones. -- Highlights: Black-Right-Pointing-Pointer Levofloxacin has cytotoxic effect on rabbit ACL cells in vitro. Black-Right-Pointing-Pointer Levofloxacin induces apoptosis in ACL cells. Black-Right-Pointing-Pointer It decreases extracellular matrix by upregulation of matrix degrading enzymes. Black-Right-Pointing-Pointer ACL cells are more susceptible to cytotoxicity by fluoroquinolones. Black-Right-Pointing-Pointer Our study suggests a potential adverse effect of fluoroquinolones.

Deng, Yu; Chen, Biao; Qi, Yongjian [Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan (China)] [Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan (China); Magdalou, Jacques [UMR 7561 CNRS-Nancy Universite, Faculte de Medicine, Vandoeuvre-les-Nancy (France)] [UMR 7561 CNRS-Nancy Universite, Faculte de Medicine, Vandoeuvre-les-Nancy (France); Wang, Hui [Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan (China)] [Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan (China); Chen, Liaobin, E-mail: lbchen@whu.edu.cn [Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan (China)] [Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan (China)

2011-11-15

372

Anterior cruciate ligament reconstruction with Achilles tendon allografts in revisions and in patients older than 30.  

PubMed

We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions. Patients were evaluated with physical examination, questionnaires, and x-rays. Twenty of the 23 patients were evaluated a mean of 28 months after surgery. There were 5 failures (21%); 3 acute failures were not evaluated at follow-up. One patient had an infection that required graft removal, 2 patients had mechanical failure of the grafts, and 2 had displacements of more than 5.5 mm as measured with a KT-1000 arthrometer. The 18 clinically successful cases had full motion, no thigh atrophy, and no effusion. Pivot shift scores were 55% A and 45% B on the International Knee Documentation Committee (IKDC) scale. Lachman scores were 40% A, 55% B, and 5% C on the IKDC scale. The KT-1000 difference was a mean of 2.9 mm at final follow-up. However, knees loosened a mean of 4.5 mm from the immediate postoperative measurements (P<.0001). Mean Lysholm and Tegner scores were 86.8 and 5.2, respectively. Tibial tunnel diameter increased by 3.1 mm on anteroposterior x-rays and 3.0 mm on lateral x-rays. Five patients developed mild medial compartment arthritis. Four of the 5 grafts with failures were from donors older than 40. Postoperative complications included deep vein thrombosis and inflammatory effusion (white blood cell count, 15,000). Twenty-one percent of ACL reconstructions with Achilles tendon allografts failed. Grafts deemed successful still had significant loosening at final follow-up. Allografts from donors older than 40 may have played a role in these failures. From the data in this study, it appears that surgeons should scrutinize the source of the allograft tissue and the age of the donor. PMID:18716694

Grafe, Michael W; Kurzweil, Peter R

2008-06-01

373

No Association of Time From Surgery With Functional Deficits in Athletes After Anterior Cruciate Ligament Reconstruction  

PubMed Central

Background Release for full activity and return to sport after anterior cruciate ligament reconstruction (ACLR) is often dictated by time from surgery and subjective opinion by the medical team. Temporal guidelines for return to sport may not accurately identify impaired strength and neuromuscular control, which are associated with increased risk for second injury (contralateral and/or ipsilateral limb) after ACLR in athletes. Hypotheses Athletes undergoing ACLR and returning to sport would demonstrate functional deficits that would not be associated with time from surgery. Study Design Controlled laboratory study. Methods Thirty-three male (n = 10) and female (n = 23) athletes with unilateral ACLR, who were cleared by a physician to return to their sport after surgery and rehabilitation, performed the single-legged vertical hop test for 10 seconds on a portable force plate. Matched teammates of each patient were recruited to serve as sex-, sport-, and age-matched controls (CTRL; n = 67). Maximum vertical ground-reaction force (VGRF) was measured during each single-limb landing. Single-limb symmetry index (LSI) was calculated as the ratio of the involved divided by uninvolved limb, expressed as a percentage. Results The single-limb vertical jump height LSI was reduced in the ACLR group, 89% (95% confidence interval [CI], 83%–95%), compared with the matched CTRL group, 101% (95% CI, 96%–105%; P<.01). The LSI for VGRF normalized to potential energy achieved during flight of the hop was increased in ACLR at 112% (95% CI, 106%–117%) relative to the CTRL group at 102% (95% CI, 98%–106%; P<.01). Linear regression analysis indicated that time from surgery was not associated with limb symmetry deficits in the ACLR group (P >.05; R2 = .002–.01). Conclusion Deficits in unilateral force development (vertical jump height) and absorption (normalized VGRF) persist in an athlete’s single-limb performance after ACLR and full return to sports. These symmetry deficits appear to be independent of time after reconstruction. Clinical Relevance On the basis of these results, clinicians should consider assessment of single-limb power performance in the decision-making process for return-to-sport release. Persistent side-to-side asymmetries may increase the risk of contralateral and/or ipsilateral injury. PMID:22879403

Myer, Gregory D.; Martin, Larry; Ford, Kevin R.; Paterno, Mark V.; Schmitt, Laura C.; Heidt, Robert S.; Colosimo, Angelo; Hewett, Timothy E.

2014-01-01

374

Joint position sense and rehabilitation in the anterior cruciate ligament deficient knee.  

PubMed Central

BACKGROUND: Impaired joint position sense (JPS) has been shown in anterior cruciate ligament (ACL) deficient and osteoarthritic knees. The relation between JPS and function is uncertain. The aim of this study was to determine further if ACL deficient knees show abnormal JPS and the effect of exercise therapy on JPS, and also to assess the relation between JPS, functional stability, and strength. METHODS: Fifty patients (46 men and four women, mean age 26.3 years) with unilateral ACL deficient knees were assessed on admission and after rehabilitation (5 hours a day for four weeks). JPS was assessed by reproduction of passive positioning using a visual analogue incorporating a goniometer. Knee stability was analysed by self report questionnaire (score 0-280) and functional activity test (single leg hop and figure of eight run). Isokinetic dynamometry was performed to evaluate quadriceps and hamstring peak torque strength. Controls were either age and sex matched individuals or the contralateral knee. Statistical analysis was by Wilcoxon signed rank test and Spearman rank order correlation coefficient. RESULTS: JPS was impaired in ACL deficient knees. The mean (SD) errors in reproducing angles were 9.4 (3.1) degrees and 7.1 (2.3) degrees for the ACL deficient knee and control knee respectively (P < 0.0005). There was no improvement in JPS after rehabilitation (9.4 (3.1) degrees and 8.5 (3.2) degrees before and after rehabilitation respectively, P = 0.14). There was improvement as ascertained from the questionnaire (on admission 202 (32.1), after rehabilitation 243 (25.4), P < 0.0001) and functional activity testing (hop: on admission 148.7 (37.3) cm, after rehabilitation 169.8 (31.1) cm, P < 0.0005; figure of eight: on admission 48.4 (16.6) seconds, after rehabilitation 41.6 (3.4) seconds, P < 0.0001). Quadriceps strength improved (peak torque on admission 198.5 (58.9) Nm, after rehabilitation 210.5 (54.2) Nm, P < 0.05), but not hamstring strength (peak torque on admission 130.6 (28.1) Nm, after rehabilitation 135.5 (27.7) Nm, P = 0.24). JPS did not correlate with the functional activity tests (hop and figure of eight run), the responses to the questionnaire, or strength. There was no correlation between the responses to the questionnaire and functional activity tests or muscle strength. CONCLUSIONS: JPS was impaired in ACL deficient knees. Although knee stability improved with exercise therapy, there was no improvement in JPS. The role of JPS in the stability of ACL deficient knees remains unclear. PMID:9298555

Carter, N D; Jenkinson, T R; Wilson, D; Jones, D W; Torode, A S

1997-01-01

375

Effects of an Accelerated Rehabilitation Program after Anterior Cruciate Ligament Reconstruction with Combined Semitendinosus-Gracilis Autograft and a Ligament Augmentation Device  

Microsoft Academic Search

Forty patients with anterior cruciate reconstructions using semitendinosus and gracilis autografts and a liga ment augmentation device were reviewed at a minimum of 20 months postoperatively to determine if an accel erated rehabilitation program was detrimental to inter mediate follow-up results. The rehabilitation program included immediate full weightbearing, using crutches as aids for 2 weeks only, and a Generation II

Peter B. MacDonald; David Hedden; Ondrej Pacin; David Huebert

1995-01-01

376

Association between abnormal kinematics and degenerative change in knees of people with chronic anterior cruciate ligament deficiency: A magnetic resonance imaging study  

Microsoft Academic Search

Progressive degeneration of the anterior cruciate ligament (ACL) deficient knee may be partly due to chondral trauma at the time of ACL rupture and repeat episodes of subluxation, but also due to aberrant kinematics altering the wear pattern at the tibiofemoral interface. The hypothesis that altered kinematics, represented by the tibiofemoral contact pattern, would be associated with articular cartilage degeneration

Jennifer M Scarvell; Paul N Smith; Kevin R Woods

2005-01-01

377

The healing medial collateral ligament following a combined anterior cruciate and medial collateral ligament injury––a biomechanical study in a goat model  

Microsoft Academic Search

The ideal treatment of a combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injury to the knee is still debated. In particular, the question of whether reconstruction of the ACL can provide the knee with sufficient multidirectional stability to allow for effective MCL healing needs to be better elucidated. Therefore, the first objective of this study was to

Steven D. Abramowitch; Masayoshi Yagi; Eiichi Tsuda; Savio L.-Y. Woo

2003-01-01

378

Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport  

Microsoft Academic Search

The purposes of this multi-center study were: (a) to document the location and type of meniscal and chondral lesions that accompany anterior cruciate ligament (ACL) tears, and (b) to test for possible relationships between these lesions and patient age, time from initial injury (TFI), and sports level (i.e., recreation, amateur, professional, and national). The cases of 764 patients with ACL

Reha N. Tandogan; Ömer Ta?er; As?m Kayaalp; Emin Ta?k?ran; Halit P?nar; Bülent Alparslan; Aziz Alturfan

2004-01-01

379

Ligament Stability Two to Six Years After Anterior Cruciate Ligament Reconstruction with Autogenous Patellar Tendon Graft and Participation in Accelerated Rehabilitation Program  

Microsoft Academic Search

We studied patients who participated in our accelerated rehabilitation program after anterior cruciate ligament reconstructive surgery to determine if they showed signs of patellar tendon graft stretching. This program initiated in 1987 emphasizes early full hyperextension, early weightbearing as tolerated, and closed-chain functional activities with rapid return to sports when the patient has attained full range of motion, approximately 65%

K. Donald Shelbourne; Thomas E. Klootwyk; John H. Wilckens; Mark S. De Carlo

1995-01-01

380

Local administration of TGF?-1\\/VEGF 165 gene-transduced bone mesenchymal stem cells for Achilles allograft replacement of the anterior cruciate ligament in rabbits  

Microsoft Academic Search

Graft remodeling following anterior cruciate ligament (ACL) reconstruction requires a long period of recovery before it is capable of withstanding physiological loads. Graft revascularization is extremely important in the remodeling process. In ACL reconstruction, the local administration of vascular endothelial growth factor (VEGF) significantly increased revascularization of the graft, but did not significantly affect the mechanical properties of the graft

Xuelei Wei; Zebin Mao; Yu Hou; Lin Lin; Tao Xue; Lianxu Chen; Haijun Wang; Changlong Yu

2011-01-01

381

Influence of Bundle Diameter and Attachment Point on Kinematic Behavior in Double Bundle Anterior Cruciate Ligament Reconstruction Using Computational Model  

PubMed Central

A protocol to choose the graft diameter attachment point of each bundle has not yet been determined since they are usually dependent on a surgeon's preference. Therefore, the influence of bundle diameters and attachment points on the kinematics of the knee joint needs to be quantitatively analyzed. A three-dimensional knee model was reconstructed with computed tomography images of a 26-year-old man. Based on the model, models of double bundle anterior cruciate ligament (ACL) reconstruction were developed. The anterior tibial translations for the anterior drawer test and the internal tibial rotation for the pivot shift test were investigated according to variation of bundle diameters and attachment points. For the model in this study, the knee kinematics after the double bundle ACL reconstruction were dependent on the attachment point and not much influenced by the bundle diameter although larger sized anterior-medial bundles provided increased stability in the knee joint. Therefore, in the clinical setting, the bundle attachment point needs to be considered prior to the bundle diameter, and the current selection method of graft diameters for both bundles appears justified. PMID:24516506

Kwon, Oh Soo; Purevsuren, Tserenchimed; Park, Won Man; Kwon, Tae-Kyu; Kim, Yoon Hyuk

2014-01-01

382

Serum CTXii Correlates With Articular Cartilage Degeneration After Anterior Cruciate Ligament Transection or Arthrotomy Followed by Standardized Exercise  

PubMed Central

Background: Anterior cruciate ligament injury increases risk for accelerated development of osteoarthritis. The effect of exercise on articular cartilage following joint injury is not well understood. Biochemical biomarkers of collagen degradation and proteoglycan turnover are potential indicators for early articular cartilage degeneration. Hypothesis: This study tests the hypothesis that serum concentrations of CS846 and CTXii correlate with structural changes to articular cartilage following joint injury in exercised animals. Study Design: Controlled laboratory study. Methods: Twenty-four Sprague-Dawley rats underwent either arthrotomy alone (sham surgery) or anterior cruciate ligament transection (ACLT). Animals were recovered for 3 weeks and then exercised on a treadmill at 18 m per minute, 1 hour per day, 5 days per week, until sacrifice either 6 or 12 weeks later. Articular cartilage was assessed grossly, and histology was graded using modified Mankin, toluidine blue, and modified David-Vaudey scales. Serum collected preoperatively and at sacrifice was assayed by ELISA for CTXii and CS846. Results: At 6 weeks, gross grades (P < 0.01), modified Mankin scores (P < 0.03), and toluidine blue scores (P < 0.04) were higher, reflecting increased degeneration in ACLT animals compared with sham surgery animals. Serum CS846 increased after 6 weeks in ACLT animals (P < 0.05). Serum CTXii levels strongly correlated with Mankin degenerative scores (coefficient = 0.81, P < 0.01) and David-Vaudey histology grades (coefficient = 0.73, P < 0.01) at 6 weeks. While gross grades remained higher at 12 weeks in ACLT animals (P < 0.04), no differences were seen in serum CS846 and CTXii. Histology scores also showed no differences between ACLT and sham due to increasing degeneration in the sham surgery group. Conclusion: The strong correlation between serum CTXii and microstructural changes to articular cartilage following joint injury demonstrates potential use of serum biomarkers for early detection of cartilage degeneration. Increasing cartilage degeneration in exercised sham-surgery animals suggests that early loading may have negative effects on articular cartilage due to either mechanical injury or hemarthrosis after arthrotomy. Clinical Relevance: Patients with anterior cruciate ligament injury are at increased risk for development of posttraumatic osteoarthritis. CTXii may be useful for early detection of joint degeneration. Further study on the effects of exercise after injury is important to postinjury and postoperative rehabilitation. PMID:24179591

Coyle, Christian H.; Henry, Sarah E.; Haleem, Amgad M.; O’Malley, Michael J.; Chu, Constance R.

2012-01-01

383

Avaliação da qualidade de vida de pacientes submetidos a reconstrução do ligamento cruzado anterior e a um programa de reabilitação Assessment of quality of life of patients who underwent anterior cruciate ligament reconstruction and a rehabilitation program  

Microsoft Academic Search

Introduction: Quality of life can be defined as the expression of a conceptual model that tries to represent patient's perspectives and his\\/her level of satisfaction expressed by numbers. The objective of this study is to evaluate the parameters of quality of life of 23 patients who underwent surgery for anterior cruciate ligament reconstruction. Methods: We adopted SF-36, a generic questionnaire

Priscila Zeitune Nigri; Flavia Machado Orlando; Ana Lucia; Wirz Gava; Maria Stella Peccin; Moises Cohen

384

Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial  

PubMed Central

Objective To compare, in young active adults with an acute anterior cruciate ligament (ACL) tear, the mid-term (five year) patient reported and radiographic outcomes between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL reconstruction. Design Extended follow-up of prospective randomised controlled trial. Setting Orthopaedic departments at two hospitals in Sweden. Participants 121 young, active adults (mean age 26 years) with acute ACL injury to a previously uninjured knee. One patient was lost to five year follow-up. Intervention All patients received similar structured rehabilitation. In addition to rehabilitation, 62 patients were assigned to early ACL reconstruction and 59 were assigned to the option of having a delayed ACL reconstruction if needed. Main outcome measure The main outcome was the change from baseline to five years in the mean value of four of the five subscales of the knee injury and osteoarthritis outcome score (KOOS4). Other outcomes included the absolute KOOS4 score, all five KOOS subscale scores, SF-36, Tegner activity scale, meniscal surgery, and radiographic osteoarthritis at five years. Results Thirty (51%) patients assigned to optional delayed ACL reconstruction had delayed ACL reconstruction (seven between two and five years). The mean change in KOOS4 score from baseline to five years was 42.9 points for those assigned to rehabilitation plus early ACL reconstruction and 44.9 for those assigned to rehabilitation plus optional delayed reconstruction (between group difference 2.0 points, 95% confidence interval ?8.5 to 4.5; P=0.54 after adjustment for baseline score). At five years, no significant between group differences were seen in KOOS4 (P=0.45), any of the KOOS subscales (P?0.12), SF-36 (P?0.34), Tegner activity scale (P=0.74), or incident radiographic osteoarthritis of the index knee (P=0.17). No between group differences were seen in the number of knees having meniscus surgery (P=0.48) or in a time to event analysis of the proportion of meniscuses operated on (P=0.77). The results were similar when analysed by treatment actually received. Conclusion In this first high quality randomised controlled trial with minimal loss to follow-up, a strategy of rehabilitation plus early ACL reconstruction did not provide better results at five years than a strategy of initial rehabilitation with the option of having a later ACL reconstruction. Results did not differ between knees surgically reconstructed early or late and those treated with rehabilitation alone. These results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear. Trial registration Current Controlled Trials ISRCTN84752559. PMID:23349407

2013-01-01

385

Physeal-Sparing Technique for Femoral Tunnel Drilling in Pediatric Anterior Cruciate Ligament Reconstruction Using a Posteromedial Portal  

PubMed Central

Pediatric anterior cruciate ligament (ACL) tears present a technical dilemma for orthopaedic surgeons. Multiple surgical techniques have been described to protect the distal femoral and proximal tibial physes. We present an ACL reconstruction technique performed on a 12-year-old girl with open physes who sustained an ACL tear after a noncontact twisting injury while playing soccer. A hamstring autograft reconstruction was performed by use of a posteromedial portal to drill the femoral tunnel in an all-epiphyseal fashion at the anatomic footprint of the native ACL. This case provides a new surgical technique to achieve anatomic fixation for ACL reconstruction in a skeletally immature individual using a posteromedial portal to drill a physeal-sparing lateral femoral tunnel for anatomic ACL reconstruction. This advancement may make drilling the femoral tunnel less technically challenging compared with other proposed methods while maintaining the lateral wall of the distal femur. PMID:24892013

Lemos, Stephen E.; Keating, Patrick M.; Scott, Timothy P.; Siwiec, Ryan M.

2013-01-01

386

Tibia Rotational Technique to Drill Femoral Bone Tunnel in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction  

PubMed Central

In anatomic anterior cruciate ligament (ACL) reconstruction, several pitfalls in creating the femoral bone tunnels at the correct position are of great concern. Our new method, the tibia rotational (TR) technique, may contribute to resolving these. The purpose of this study is to describe further details about the TR technique in anatomic double-bundle ACL reconstruction. Both anteromedial and posterolateral femoral bone tunnels were drilled through a posterolateral tibial bone tunnel using tibial rotation without deep knee flexion. When it is difficult to reach the mark with the rigid guide pin, the narrow curved TR technique guide and the flexible drill system allow drilling femoral bone tunnels in the correct position. The TR technique offers the technical ease required for widespread acceptance while prioritizing the fundamental goals of an anatomic double-bundle ACL reconstruction. PMID:25276609

Mitani, Genya; Takagaki, Tomonori; Hamahashi, Kosuke; Kaneshiro, Nagatoshi; Serigano, Kenji; Maeda, Takashi; Nakamura, Yutaka; Mochida, Joji

2014-01-01

387

Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries.  

PubMed

Combined anterior cruciate ligament (ACL) and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of the ACL reconstruction have been reported when the posterolateral instability has been left untreated. The purpose of this article is to describe our surgical technique, and present the results of 34 chronic combined ACL posterolateral reconstructions in 34 knees using allograft tissue, and evaluating these patient outcomes with KT 1000 knee ligament arthrometer, Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales. In addition, observations regarding patient demographics with combined ACL posterolateral instability, postoperative range of motion loss, postinjury degenerative joint disease, infection rate, return to function, and the use of radiated and nonirradiated allograft tissues will be presented. PMID:24949986

Fanelli, Gregory C; Fanelli, David G; Edson, Craig J; Fanelli, Matthew G

2014-10-01

388

A new technique to avoid articular cartilage injury in anterior cruciate ligament reconstruction through far antero-medial portal.  

PubMed

Far antero-medial (FAM) portal technique is usually used in our department in anterior cruciate ligament (ACL) reconstruction when drilling the femoral tunnel. Although the FAM portal technique carries potential risks, such as cartilage injury of the lateral femoral condyle, peroneal nerve injury and blow out of the lateral femoral condyle's posterior wall, these problems were resolved in a cadaveric study, in which 110°-120°knee flexion was recommended when drilling the femoral tunnel. However, there is a potential risk of injuring the cartilage of the medial femoral condyle especially when drilling the postero-lateral bundle. A new method is proposed to ensure that the femoral tunnel drilling does not damage the cartilage of the medial femoral condyle. PMID:25281552

Kamei, G; Ochi, M; Usman, M A; Mahmoud, E H

2014-11-01

389

Panax notoginseng saponins promote wound repair of anterior cruciate ligament through phosphorylation of PI3K, AKT and ERK  

PubMed Central

Panax notoginseng saponins (PNS) are components derived from Chinese herb panax notoginseng and play important roles in the cure of wounds. However, how PNS plays this function is still unclear. In this study, we used MTT assay, wound healing assay, western blot, quantitative real time PCR and enzyme-linked immunosorbent assay to detect the effects of PNS on the proliferation, migration and expression of collagen and fibronectin of anterior cruciate ligament (ACL) fibroblasts as well as the underlying mechanism. We found that PNS promoted the proliferation and migration of ACL fibroblasts and increased the expression levels of collagen and fibronectin. Further mechanism study indicates that PNS might play its function through the phosphorylation of PI3K, AKT and ERK. This study provides a possible mechanism for the function of PNS and lays foundation for further study on the function of panax notoginseng. PMID:25755732

Yu, Lu; Xie, Jingwei; Xin, Na; Wang, Zhanyou

2015-01-01

390

Insufficiency fracture of the tibial plateau after anterior cruciate ligament reconstructive surgery: a case report and review of the literature.  

PubMed

Peri-articular fractures after anterior cruciate ligament (ACL) reconstructive surgery are rare. To our knowledge, this case documents the first insufficiency fracture of the tibial plateau after ACL reconstruction, which presented three weeks after the procedure. A 25-year-old female recreational soccer player suffered an insufficiency fracture of the tibial plateau, extending 1.5 mm into the anterior wall of tibial tunnel and medial compartment under the anterior horn of medial meniscus, which presented as a diagnostic challenge. Clinically, the fracture mimicked a low-grade infection of the surgical site, while radiographically, the fracture resembled an avulsion fracture, later confirmed as a tibial tunnel fracture with computed tomography. With the ACL graft integrity not in jeopardy, four weeks of non-weightbearing and a delayed post-operative rehabilitation program was effective in allowing the fracture to heal. Good functional outcome was achieved after conservative management, with minimal loss of terminal knee extension and minimal pain at 22-month follow-up. PMID:23754857

Wong, Jessica J; Muir, Brad

2013-06-01

391

Insufficiency fracture of the tibial plateau after anterior cruciate ligament reconstructive surgery: a case report and review of the literature  

PubMed Central

Peri-articular fractures after anterior cruciate ligament (ACL) reconstructive surgery are rare. To our knowledge, this case documents the first insufficiency fracture of the tibial plateau after ACL reconstruction, which presented three weeks after the procedure. A 25-year-old female recreational soccer player suffered an insufficiency fracture of the tibial plateau, extending 1.5 mm into the anterior wall of tibial tunnel and medial compartment under the anterior horn of medial meniscus, which presented as a diagnostic challenge. Clinically, the fracture mimicked a low-grade infection of the surgical site, while radiographically, the fracture resembled an avulsion fracture, later confirmed as a tibial tunnel fracture with computed tomography. With the ACL graft integrity not in jeopardy, four weeks of non-weightbearing and a delayed post-operative rehabilitation program was effective in allowing the fracture to heal. Good functional outcome was achieved after conservative management, with minimal loss of terminal knee extension and minimal pain at 22-month follow-up. PMID:23754857

Wong, Jessica J.; Muir, Brad

2013-01-01

392

Clinical Correlates to Laboratory Measures for use in Non-Contact Anterior Cruciate Ligament Injury Risk Prediction Algorithm  

PubMed Central

Background Prospective measures of high knee abduction moment during landing identify female athletes at high risk for non-contact anterior cruciate ligament injury. Biomechanical laboratory measurements predict high knee abduction moment landing mechanics with high sensitivity (85%) and specificity (93%). The purpose of this study was to identify correlates to laboratory-based predictors of high knee abduction moment for use in a clinic-based anterior cruciate ligament injury risk prediction algorithm. The hypothesis was that clinically obtainable correlates derived from the highly predictive laboratory-based models would demonstrate high accuracy to determine high knee abduction moment status. Methods Female basketball and soccer players (N=744) were tested for anthropometrics, strength and landing biomechanics. Pearson correlation was used to identify clinically feasible correlates and logistic regression to obtain optimal models for high knee abduction moment prediction. Findings Clinical correlates to laboratory-based measures were identified and predicted high knee abduction moment status with 73% sensitivity and 70% specificity. The clinic-based prediction algorithm, including (Odds Ratio: 95% confidence interval) knee valgus motion (1.43:1.30–1.59 cm), knee flexion range of motion (.98:0.96–1.01 deg), body mass (1.04:1.02–1.06 kg), tibia length (1.38:1.25–1.52 cm) and quadriceps to hamstring ratio (1.70:1.06–2.70) predicted high knee abduction moment status with C statistic 0.81. Interpretation The combined correlates of increased knee valgus motion, knee flexion range of motion, body mass, tibia length and quadriceps to hamstrings ratio predict high knee abduction moment status in female athletes with high sensitivity and specificity. PMID:20554101

Myer, Gregory D.; Ford, Kevin R.; Khoury, Jane; Succop, Paul; Hewett, Timothy E.

2010-01-01

393

Single-versus two-incision technique in anterior cruciate ligament replacement: influence on postoperative muscle function.  

PubMed

The purpose of this study was to find out whether the single-incision technique for anterior cruciate ligament repair has advantages over the two-incision technique in terms of muscular function up to 1 year postoperatively. Twenty patients who underwent unilateral anterior cruciate ligament reconstruction with bone-patellar tendon-bone autografts were randomly assigned to one of the two procedures. Both groups (10 patients in each) were followed up at 1 year. Lysholm and International Knee Documentation scores and thigh circumferences were markedly reduced after surgery in both groups but improved up until the last follow-up examination at 12 months postoperatively. Clinical examination, functional scores, stabilometry measurements, and thigh circumferences did not differ between the two groups. Isokinetic evaluation revealed a significant reduction of extensor peak torques in both groups that was most pronounced at 3 months, then improved continuously but was still present 12 months postoperatively. A significant reduction of peak torques, up to 35%, was seen in the flexor muscles of the involved legs compared with the contralateral legs, but this deficit vanished completely after 12 months in both groups. At 3 and 6 months, for the flexor as well as the extensor muscles, the deficits in peak torque on the injured sides were found to have improved faster in the single-incision group. These results indicate improved dynamic muscle function with use of the single-incision technique because the dissection of the vastus lateralis muscle that occurs in the two-incision technique is avoided. PMID:11798992

Hess, Thomas; Duchow, Jochen; Roland, Stephan; Kohn, Dieter

2002-01-01

394

Sex-Specific Gait Adaptations Prior to and up to 6 Months After Anterior Cruciate Ligament Reconstruction.  

PubMed

Study Design Controlled longitudinal laboratory study. Objectives To compare sagittal plane gait mechanics of men and women before and up to 6 months after anterior cruciate ligament reconstruction (ACLR). Background Aberrant gait patterns are ubiquitous after anterior cruciate ligament (ACL) rupture and persist after ACLR despite skilled physical therapy. Sex influences postoperative function and second-ACL injury risk, but its influence on gait adaptations after injury has not been investigated. Methods Sagittal plane knee and hip joint excursions during midstance and internal knee and hip extension moments at peak knee flexion were collected in 12 women and 27 men using 3-D gait analysis before (screening) and after preoperative physical therapy (presurgery), and 6 months after ACLR (6 months postsurgery). Repeated-measures analysis-of-variance models were used to determine whether limb asymmetries changed differently over time in men and women. Results Significant time-by-limb-by-sex interactions were identified for hip and knee excursions and internal knee extension moments (P?.007). Both sexes demonstrated smaller knee excursions on the involved limb compared to the uninvolved limb at each time point (P?.007), but only women demonstrated a decrease in the involved knee excursion from presurgery to 6 months postsurgery (P = .03). Women also demonstrated smaller hip excursions (P<.001) and internal knee extension moments (P = .005) on the involved limb compared to the uninvolved limb at 6 months postsurgery. Men demonstrated smaller hip excursions and knee moments on the involved limb compared to the uninvolved limb (P<.001) regardless of time. Conclusion The persistence of limb asymmetries in men and women 6 months after ACLR indicates that current postoperative rehabilitation efforts are inadequate for some individuals following ACLR. J Orthop Sports Phys Ther 2015;45(3):207-214. Epub 27 Jan 2015. doi:10.2519/jospt.2015.5062. PMID:25627155

Di Stasi, Stephanie; Hartigan, Erin H; Snyder-Mackler, Lynn

2015-03-01

395

Incidence of Contralateral and Ipsilateral Anterior Cruciate Ligament (ACL) Injury After Primary ACL Reconstruction and Return to Sport  

PubMed Central

Objective Incidence rate (IR) of an ipsilateral or contralateral injury after anterior cruciate ligament reconstruction (ACLR) is unknown. The hypotheses were that the IR of anterior cruciate ligament (ACL) injury after ACLR would be greater than the IR in an uninjured cohort of athletes and would be greater in female athletes after ACLR than male athletes. Design Prospective case–control study. Setting Regional sports community. Participants Sixty-three subjects who had ACLR and were ready to return to sport (RTS) and 39 control subjects. Independent Variables Second ACL injury and sex. Main Outcome Measures Second ACL injury and athletic exposure (AE) was tracked for 12 months after RTS. Sixteen subjects after ACLR and 1 control subject suffered a second ACL injury. Between- and within-group comparisons of second ACL injury rates (per 1000 AEs) were conducted. Results The IR of ACL injury after ACLR (1.82/1000 AE) was 15 times greater [risk ratio (RR) = 15.24; P = 0.0002) than that of control subjects (0.12/1000AE). Female ACLR athletes demonstrated 16 times greater rate of injury (RR = 16.02; P = 0.0002) than female control subjects. Female athletes were 4 (RR = 3.65; P = 0.05) times more likely to suffer a second ACL injury and 6 times (RR = 6.21; P = 0.04) more likely to suffer a contralateral injury than male athletes. Conclusions An increased rate of second ACL injury after ACLR exists in athletes when compared with a healthy population. Female athletes suffer contralateral ACL injuries at a higher rate than male athletes and seem to suffer contralateral ACL injuries more frequently than graft re-tears. The identification of a high-risk group within a population of ACLR athletes is a critical step to improve outcome after ACLR and RTS. PMID:22343967

Paterno, Mark V.; Rauh, Mitchell J.; Schmitt, Laura C.; Ford, Kevin R.; Hewett, Timothy E.

2014-01-01

396

Arthroscopic Repair of Chronic Bony Bankart Lesion Using a Low Anterior Portal  

PubMed Central

We describe the repair of a chronic bony Bankart lesion in a case with recurrent instability using standard techniques and equipment for addressing anteroinferior glenohumeral instability. A 25-year-old man with recurrent instability and a chronic bony Bankart lesion with a Hill-Sachs lesion was treated. The inferior 2 sutures and knotless anchors are placed through a low anterior portal, which improves the angle of approach to the inferior portion of the glenoid that is fractured. The knotless anchors are impacted through the low anterior portal, just superior to the level of the suture, as the fragment tends to retract medially and inferiorly, with the drill guide slightly on the face of the glenoid. The superior-anterior portal adjacent to the biceps tendon gives a better view of the glenoid articular cartilage position of the anchors required to restore the anatomic location of the fracture fragment. The low anterior portal improved and simplified the reduction of the fracture fragment to the glenoid neck by allowing access to the anterior-inferior bony Bankart lesion that was repairable with suture and knotless anchors using standardized techniques. PMID:23766999

Brand, Jefferson C.; Westerberg, Paul

2012-01-01

397

The Role of Fibers in the Femoral Attachment of the Anterior Cruciate Ligament in Resisting Tibial Displacement  

PubMed Central

Purpose The purpose was to clarify the load-bearing functions of the fibers of the femoral anterior cruciate ligament (ACL) attachment in resisting tibial anterior drawer and rotation. Methods A sequential cutting study was performed on 8 fresh-frozen human knees. The femoral attachment of the ACL was divided into a central area that had dense fibers inserting directly into the femur and anterior and posterior fan-like extension areas. The ACL fibers were cut sequentially from the bone: the posterior fan-like area in 2 stages, the central dense area in 4 stages, and then the anterior fan-like area in 2 stages. Each knee was mounted in a robotic joint testing system that applied tibial anteroposterior 6-mm translations and 10° or 15° of internal rotation at 0° to 90° of flexion. The reduction of restraining force or moment was measured after each cut. Results The central area resisted 82% to 90% of the anterior drawer force; the anterior fan-like area, 2% to 3%; and the posterior fan-like area, 11% to 15%. Among the 4 central areas, most load was carried close to the roof of the intercondylar notch: the anteromedial bundle resisted 66% to 84% of the force and the posterolateral bundle resisted 16% to 9% from 0° to 90° of flexion. There was no clear pattern for tibial internal rotation, with the load shared among the posterodistal and central areas near extension and mostly the central areas in flexion. Conclusions Under the experimental conditions described, 66% to 84% of the resistance to tibial anterior drawer arose from the ACL fibers at the central-proximal area of the femoral attachment, corresponding to the anteromedial bundle; the fan-like extension fibers contributed very little. This work did not support moving a single-bundle ACL graft to the side wall of the notch or attempting to cover the whole attachment area if the intention was to mimic how the natural ACL resists tibial displacements. Clinical Relevance There is ongoing debate about how best to reconstruct the ACL to restore normal knee function, including where is the best place for ACL graft tunnels. This study found that the most important area on the femur, in terms of resisting displacement of the tibia, was in the central-anterior part of the femoral ACL attachment, near the roof of the intercondylar notch. The testing protocol did not lead to data that would support using a large ACL graft tunnel that attempts to cover the whole natural femoral attachment area. PMID:25530509

Kawaguchi, Yasuyuki; Kondo, Eiji; Takeda, Ryo; Akita, Keiichi; Yasuda, Kazunori; Amis, Andrew A.

2015-01-01

398

[Anterior laxity and internal arthritis of the knee. Results of the reconstruction of the anterior cruciate ligament associated with tibial osteotomy].  

PubMed

Fifty-one knees were reviewed out of 53 which had been operated on (between 1981 and 1991) for instability due to a long-standing rupture of the anterior cruciate ligament (A.C.L.), associated with medial arthritis related to a varus deformity. They had undergone a reconstruction of the cruciate ligament using the patellar tendon (5 cases had received an artificial ligament) and a high tibial osteotomy. In 80 per cent of cases this was an opening osteotomy with interposition of a heterologous bone graft, and in 39 cases it was a closing osteotomy. The average age was 37 +/- 6 years. The oldest patient was 58 years old. 80 per cent of cases were men and 88 per cent of the patients practised sport on a regular basis at the time of the accident. The average delay before surgery was 9.5 years. Almost all the patients has already undergone a medial meniscectomy and there were deep cartilaginous lesions and the bone was exposed in 50 per cent of cases. 28 knees were reexamined after a follow-up of over 4 years. Based on the ARPEGE score the results on pain and stability were good. Return to sport has been possible for 43 per cent of patients. Pivot shift, which was constant before surgery (grade 2 or 3), disappeared in 20 cases and was estimated at grade 1 in 8 cases (of which 6 had suffered a rupture of the graft). For the 20 cases in which the reconstruction of the A.C.L. had held, the average anterior radiological subluxation was 4.3 +/- 3.2 mm (from 2 to 14 mm) and the average gain after surgery was 6.7 +/- 3.7 mm (from 2.5 to 18 mm). The femoro-tibial angle went from an average of 6 degrees of varus to 3 degrees of valgus. The opening osteotomy was more precise for correction in the frontal plane. A large valgus (over 3 degrees) was not desirable and a hypercorrection was occasionally difficult to accept by relatively young patients who are likely to take up sport again. The osteotomy often involuntarily modified the normal posterior tibial plateau slope (especially closing osteotomy). A backwards increase of the tibial plateau slope is a factor which increases the anterior subluxation of the femur on the tibia. This is confirmed before and after surgery. It seems preferable to decrease the tibial slope during the osteotomy in order to protect the A.C.L. reconstruction.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8066285

Lerat, J L; Moyen, B; Garin, C; Mandrino, A; Besse, J L; Brunet-Guedj, E

1993-01-01

399

THE RELIABILITY OF THE VAIL SPORT TEST™ AS A MEASURE OF PHYSICAL PERFORMANCE FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION  

PubMed Central

Purpose/Background: The decision to return an athlete to sports following anterior cruciate ligament reconstruction can be controversial. The purposes of this study are 1) to describe a functional test (Vail Sport Test™) that includes the evaluation of muscle strength, endurance, power, and movement quality in those patients attempting to return to sports following ACL reconstruction and 2) to assess the reliability of the Vail Sport Test™. Methods: A prospective cohort study design. A total of 30 (12 F, 18 M) subjects (18.1±5.3 yrs) volunteered for the study. All subjects were post-operative ACL reconstruction (5.2±1.9 months) and were in the process of returning to sports. Each subject completed the Vail Sport Test™ and was videotaped from the anterior and lateral view. The videotape was then viewed and graded at two different points in time (48 hours apart) by three licensed physical therapists. Intraclass correlations (ICCs) were calculated to determine intra- and inter-rater reliability. Results: Intra-rater reliability was excellent with a range of .95 to 1.0. Reliability values between graders were .97 (ICC2,k) and 1.55 (SEM). Conclusions: The results of this study suggest that the Vail Sport Test™ has excellent reliability when the same graders scored the test using video on repeated occasions. In addition, the test was reliable between different graders. Level of Evidence: Level 2b PMID:22389868

Shanley, Ellen; Thigpen, Chuck; Geary, Ryan; Osler, Mike; DelGiorno, Jackie

2012-01-01

400

Comparative animal study of three ligament prostheses for the replacement of the anterior cruciate and medial collateral ligament.  

PubMed

Three different ligament prostheses (Leeds-Keio, Gore-Tex and a prototype of Aramid) were implanted in sheep knee joints replacing the anterior cruciate ligament and the medial collateral ligament. After 1 yr the knees were explanted and their biomechanical properties were assessed by a drawer test and tensile tests of the implants. Additionally the ligament replacements, the synovial membrane and the lymph nodes were inspected histologically. For each type of prosthesis partial or total ruptures occurred. None of the operated joints regained normal stability and stiffness. Anterior knee stability was best for the Gore-Tex treated group and worst for those joints that received a Leeds-Keio implant. The stiffness and rupture strength were highest for the Gore-Tex prostheses. Histologically the strongest intra-articular inflammatory response was observed in the Gore-Tex treated joints. Inside the drill tunnels the severest foreign body reaction was found for the Aramid prostheses. Gore-Tex fibres often showed good bony integration. Wear particles formed from all prostheses and caused small granulomas and mild synovities. The results suggest that none of the tested materials represent an ideal solution for ligament replacement. Relatively good stability does not guarantee good biocompatibility and vice versa. This suggests that ligament prostheses should be applied only in salvage cases. PMID:8736731

Dürselen, L; Claes, L; Ignatius, A; Rübenacker, S

1996-05-01

401

A technique for arthroscopic fasciotomy for the chronic exertional tibialis anterior compartment syndrome  

Microsoft Academic Search

Chronic exertional anterior compartment syndrome (CECS) is a condition that causes pain over the front of the shin bone that\\u000a usually occurs in physically active people, especially runners. It may require sometimes an immediate fasciotomy. A longitudinal\\u000a incision just over the fibula has used as surgical treatment bad cosmetic appearance. Although nowadays mini surgical incisions\\u000a are preferred. The aim of

Ahmet Sebik; Ali Do?an

2008-01-01

402

Tibial Fixation of Bone-Patellar Tendon-Bone Grafts in Anterior Cruciate Ligament ReconstructionA Cadaveric Study of Bovine Bone Screw and Biodegradable Interference Screw  

Microsoft Academic Search

Background: The use of interference screw fixation for bone-patellar tendon-bone grafts in anterior cruciate ligament fixation is well established. No previous study has compared bovine bone screws and biodegradable interference screws or demonstrated their efficacy for requirements associated with early rehabilitation.Hypothesis: There is no difference in tension loss and pull-out strength between bovine bone screws and biodegradable interference screws.Study Design:

Naiquan Zheng; Chad T. Price; Peter A. Indelicato; Bo Gao

2008-01-01

403

Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors  

Microsoft Academic Search

Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent\\u000a to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes\\u000a the most time lost from competition in soccer which has influenced a strong research focus to determine the

Eduard Alentorn-Geli; Gregory D. Myer; Holly J. Silvers; Gonzalo Samitier; Daniel Romero; Cristina Lázaro-Haro; Ramón Cugat

2009-01-01

404

Patellar Tendon Versus Hamstring Tendon Autografts for Reconstructing the Anterior Cruciate LigamentA Meta-Analysis Based on Individual Patient Data  

Microsoft Academic Search

Background: The best means of ensuring knee stability after anterior cruciate ligament (ACL) reconstruction remains a core debate in sports medicine.Hypothesis: There is no difference between ACL reconstruction with patellar tendon or hamstring tendon autografts with regard to postoperative knee laxity and instability.Study Design: Meta-analysis of individual patient data.Methods: Pooled analysis of individual patient data from 6 published randomized clinical

David Jean Biau; Sandrine Katsahian; Jüri Kartus; Arsi Harilainen; Julian A. Feller; Matjaz Sajovic; Lars Ejerhed; Stefano Zaffagnini; Martin Röpke; Rémy Nizard

2009-01-01

405

A 10Year Comparison of Anterior Cruciate Ligament Reconstructions With Hamstring Tendon and Patellar Tendon AutograftA Controlled, Prospective Trial  

Microsoft Academic Search

Background: There are no controlled, prospective studies comparing the 10-year outcomes of anterior cruciate ligament (ACL) reconstruction using patellar tendon (PT) and 4-strand hamstring tendon (HT) autografts.Hypothesis: Comparable results are possible with HT and PT autografts.Study Design: Cohort study; Level of evidence, 2.Methods: One hundred eighty ACL-deficient knees that met inclusion criteria underwent ACL reconstruction (90 HT autograft, 90 PT

Leo A. Pinczewski; Jeffrey Lyman; Lucy J. Salmon; Vivianne J. Russell; Justin Roe; James Linklater

2007-01-01

406

Histological and biomechanical studies of inter-strand healing in four-strand autograft anterior cruciate ligament reconstruction in a rabbit model  

Microsoft Academic Search

In order to observe the remodeling process of the inter-strand of the four-strand graft used for anterior cruciate ligament\\u000a (ACL) reconstruction, and to find the histological and biomechanical influences on this process by braiding the four-strand\\u000a graft, we conducted this study in a rabbit model. The rabbit’s ACLs were reconstructed with bilateral four-strand semitendinous\\u000a tendons which are in parallel or

Yan Xu; Ying-fang Ao

2009-01-01

407

Does Anterior Cruciate Ligament Reconstruction Lead to Degenerative Disease?: Thirteen-Year Results After Bone–Patellar Tendon–Bone Autograft  

Microsoft Academic Search

Background: Reporting of long-term outcome of anterior cruciate ligament (ACL) reconstruction with the patellar tendon (bone–patellar tendon–bone [BTB]) autograft is limited. There are concerns that degenerative joint disease is common in the long term, which may be associated with the procedure itself.Hypotheses: (1) ACL reconstruction with BTB provides good long-term outcome. (2) There are additional factors to surgical reconstruction that

James R. D. Murray; Amy M. Lindh; Niall A. Hogan; Alister J. Trezies; James W. Hutchinson; Erin Parish; John W. Read; Mervyn V. Cross

2012-01-01

408

Anterior cruciate ligament reconstruction with double-looped semitendinosus and gracilis tendon graft directly fixed to cortical bone: 5-year results  

Microsoft Academic Search

Forty-three patients who had undergone an anterior cruciate ligament (ACL) reconstruction using a doubled semitendinosus and gracilis graft were prospectively reviewed at 5-year follow-up. All had suffered subacute or chronic tears of the ligament. At surgery, the femoral tunnel was drilled first through the antero-medial portal. The correct position of the femoral and tibial guide wire was checked fluoroscopically. A

Francesco Giron; Paolo Aglietti; Pierluigi Cuomo; Nicola Mondanelli; Antonio Ciardullo

2005-01-01

409

Roentgen stereophotogrammetric analysis methods for determining ten causes of lengthening of a soft-tissue anterior cruciate ligament graft construct.  

PubMed

There are many causes of lengthening of an anterior cruciate ligament soft-tissue graft construct (i.e., graft+fixation devices+bone), which can lead to an increase in anterior laxity. These causes can be due to plastic deformation andor an increase in elastic deformation. The purposes of this in vitro study were (1) to develop the methods to quantify eight causes (four elastic and four plastic) associated with the tibial and femoral fixations using Roentgen stereophotogrammetric analysis (RSA) and to demonstrate the usefulness of these methods, (2) to assess how well an empirical relationship between an increase in length of the graft construct and an increase in anterior laxity predicts two causes (one elastic and one plastic) associated with the graft midsubstance, and (3) to determine the increase in anterior tare laxity (i.e., laxity under the application of a 30 N anterior tare force) before the graft force reaches zero. Markers were injected into the tibia, femur, and graft in six cadaveric legs whose knees were reconstructed with single-loop tibialis grafts. To satisfy the first objective, legs were subjected to 1500 cycles at 14 Hz of 150 N anterior force transmitted at the knee. Based on marker 3D coordinates, equations were developed for determining eight causes associated with the fixations. After 1500 load cycles, plastic deformation between the graft and WasherLoc tibial fixation was the greatest cause with an average of 0.8+/-0.5 mm followed by plastic deformation between the graft and cross-pin-type femoral fixation with an average of 0.5+/-0.1 mm. The elastic deformations between the graft and tibial fixation and between the graft and femoral fixation decreased averages of 0.3+/-0.3 mm and 0.2+/-0.1 mm, respectively. The remaining four causes associated with the fixations were close to 0. To satisfy the remaining two objectives, after cyclic loading, the graft was lengthened incrementally while the 30 N anterior tare laxity, 150 N anterior laxity, and graft tension were measured. The one plastic cause and one elastic cause associated with the graft midsubstance were predicted by the empirical relationships with random errors (i.e., precision) of 0.9 mm and 0.5 mm, respectively. The minimum increase in 30 N anterior tare laxity before the graft force reached zero was 5 mm. Hence, each of the eight causes of an increase in the 150 N anterior laxity associated with the fixations can be determined with RSA as long as the overall increase in the 30 N anterior tare laxity does not exceed 5 mm. However, predicting the two causes associated with the graft using empirical relationships is prone to large errors. PMID:18601444

Smith, Conrad; Hull, M L; Howell, S M

2008-08-01

410

Biomechanical testing of implant free wedge shaped bone block fixation for bone patellar tendon bone anterior cruciate ligament reconstruction in a bovine model  

PubMed Central

Background The use of an interference fit wedged bone plug to provide fixation in the tibial tunnel when using bone-patellar tendon-bone autograft for anterior cruciate ligament reconstruction offers many theoretic advantages including the potential to offer a more economical and biological alternative to screw fixation. This technique has not been subjected to biomechanical testing. We hypothesised that a wedged bone plug fixation technique provides equivalent tensile load to failure as titanium interference screw fixation. Methods In a controlled laboratory setting, anterior cruciate ligament reconstruction was performed in 36 bovine knees using bone-patella-bone autograft. In 20 knees tibial fixation relied upon a standard cuboid bone block and interference screw. In eight knees a wedge shaped bone block with an 11 mm by 10 mm base without a screw was used. In a further eight knees a similar wedge with a 13 mm by 10 mm base was used. Each specimen used a standard 10 mm tibial tunnel. The reconstructions were tested biomechanically in a physiological environment using an Instron machine to compare ultimate failure loads and modes of failure. Results Statistical analysis revealed no significant difference between wedge fixation and screw fixation (p = 0.16), or between individual groups (interference screw versus 11 mm versus 13 mm wedge fixation) (P = 0.35). Conclusions Tibial tunnel fixation using an impacted wedge shaped bone block in anterior cruciate ligament reconstruction has comparable ultimate tensile strength to titanium interference screw fixation. PMID:20813059

2010-01-01

411

Anatomic Single Bundle Anterior Cruciate Ligament Reconstruction by Low Accessory Anteromedial Portal Technique: An In Vivo 3D CT Study  

PubMed Central

Purpose Proper femoral tunnel position is important for anatomical reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to evaluate the positions of femoral and tibial tunnels created using an accessory anteromedial portal technique in single bundle ACL reconstruction. Materials and Methods The femoral tunnel was targeted at the mid-portion of the ACL bundles. We evaluated postoperative computed tomography scans of 32 patients treated by ACL reconstruction using a free-hand low accessory anteromedial portal technique. On the tibial side, the tunnel position was evaluated using Tsukada's method. On the femoral side, the position was evaluated using 1) the quadrant method, 2) Mochizuki's method, 3) Mochizuki's method, and 4) Takahashi's method. Tunnel obliquity was also evaluated. Results The mean tibial tunnel position was located at 44.6%±2.5% anterior from the anterior margin and 48.0%±3.0% in medial from the medial margin. The mean femoral tunnel position was located at the center between the anteromedial and posterolateral bundles: Quadrant method, 26.7%±2.7%/30.0%±2.9%; Watanabe's method, 37.7%±2.5%/26.6%±2.2%; Mochizuki's method, 38.7%±2.7%; Takahashi's method, 21.8%±2.2%. The mean femoral tunnel obliquity was 57.7°±6.2° in the sagittal plane and 49.9°±5.6° in the coronal plane. Conclusions In anatomic single bundle ACL reconstruction, the low anteromedial portal technique can restore accurate position of the native footprint. Accurate femoral tunnel position facilitates recovery of stability and decreases graft failure rate. PMID:24944975

Lee, Kwang Won; Chi, Yong Joo; Yang, Dae Suk; Kim, Ha Yong; Choy, Won Sik

2014-01-01

412

Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence  

PubMed Central

Background Bone bruises are frequently associated with anterior cruciate ligament (ACL) tears as a result of trauma or direct shear stress of the bone. Purpose To review the evidence regarding the characteristics of the bone bruise associated with ACL tears, its relevance on clinical outcomes, and its progression over time. In particular, the long-term effects of the bone bruise on the knee osteochondral architecture and joint function were evaluated. Study design Review; level of evidence: 4. Methods An electronic search was performed on PubMed. Combinations of keywords included: “bone bruise AND knee”; “bone bruise AND anterior cruciate ligament”; “bone bruise AND osteo-chondral defects”. Any level of evidence studies concerning bone bruises in patients with partial or complete ACL tears were retrieved. Results A total of 25 studies were included; three of them investigated biomechanical parameters, seven were concerned with clinical outcomes, and 15 were radiological studies. Evaluation of the bone bruise is best performed using a fat-saturated T2-weighted fast spin echo exam or a short tau inversion recovery sequence where fat saturation is challenging. The location of the injury has been demonstrated to be more frequent in the lateral compartment of the joint (lateral femoral condyle and lateral tibial plateau). It is associated with ACL tears in approximately 70% of cases, often with collateral ligament or meniscal tears. Mid- and long-term outcomes demonstrated a complete healing of the marrow lesions at magnetic resonance imaging, but chondral defects detected with T1? sequences are still present 1 year after the ACL injury. Functional examination of the knee, through clinical International Knee Documentation Committee scores, did not show any correlation with the bone bruise. Conclusion Although bone bruise presence yields to higher pain levels, no correlation with functional outcomes was reported. Most studies have a short-term follow-up (<2 years) compared to the length of time it takes to develop post-traumatic osteoarthritis, so it still remains unclear whether the initial joint injury and bone bruise have a direct relationship to long-term function. PMID:25733936

Papalia, Rocco; Torre, Guglielmo; Vasta, Sebastiano; Zampogna, Biagio; Pedersen, Douglas R; Denaro, Vincenzo; Amendola, Annunziato

2015-01-01

413

Compliance With Neuromuscular Training and Anterior Cruciate Ligament Injury Risk Reduction in Female Athletes: A Meta-Analysis  

PubMed Central

Context No consensus exists about the influence of compliance with neuromuscular training programs on reduction of the risk of anterior cruciate ligament (ACL) injury. Objective To systematically review and synthesize the published literature to determine if compliance with neuromuscular training is associated with reduced incidence of ACL injury in young female athletes. Data Sources We searched PubMed, SPORTDiscus, CINAHL, and MEDLINE for articles published from 1995 to 2010 using the key words anterior cruciate ligament prevention, ACL prevention, knee prevention, prospective knee prevention, neuromuscular training, and neuromuscular intervention. Study Selection Criteria for inclusion required that (1) the number of ACL injuries was reported, (2) a neuromuscular training program was used, (3) females were included as participants, (4) the study design was prospective and controlled, and (5) compliance data for the neuromuscular training program were provided. Data Extraction Extracted data included the number of ACL injuries, total number of participants per group, observation time period, number of participants who completed each session, number of sessions completed by an entire team, and number of total sessions. Attendance was calculated as the number of participants who completed each session converted into a percentage of the total number of participants. Intervention completion was calculated as the number of sessions completed by an entire team converted into a percentage of the total number of training sessions. These data were used to calculate an overall rate of compliance. Data Synthesis Six of 205 identified studies were included. Incidence rates of ACL injury were lower in studies with high rates of compliance with neuromuscular training than in studies with low compliance rates (incidence rate ratio = 0.27 [95% confidence interval = 0.07, 0.80]). Tertile analysis indicated rates of ACL injury incidence were lower in studies with high compliance rates than in studies with moderate and low compliance rates (incidence rate ratio = 0.18 [95% confidence interval = 0.02, 0.77]). Conclusions A potential inverse dose-response relationship exists between compliance with neuromuscular training and incidence of ACL injury. Attending and completing recommended neuromuscular sessions appears to be an important factor for preventing ACL injuries. PMID:23182020

Sugimoto, Dai; Myer, Gregory D.; Bush, Heather M.; Klugman, Maddie F.; McKeon, Jennifer M. Medina; Hewett, Timothy E.

2012-01-01

414

A musculoskeletal modeling approach for estimating anterior cruciate ligament strains and knee anterior-posterior shear forces in stop-jumps performed by young recreational female athletes.  

PubMed

The central goal of this study was to contribute to the advancements being made in determining the underlying causes of anterior cruciate ligament (ACL) injuries. ACL injuries are frequently incurred by recreational and professional young female athletes during non-contact impact activities in sports like volleyball and basketball. This musculoskeletal-neuromuscular study investigated stop-jumps and factors related to ACL injury like knee valgus and internal-external moment loads, knee anterior-posterior (AP) shear forces, ACL strains and internal forces. Motion capture data was obtained from the landing phase of stop-jumps performed by eleven young recreational female athletes and electromyography (EMG) data collected from quadriceps, hamstring and gastrocnimius muscles which were then compared to numerically estimated activations. Numerical simulation tools used were Inverse Kinematics, Computed Muscle Control and Forward Dynamics and the knee modeled as a six degree of freedom joint. Results showed averaged peak strains of 12.2 ± 4.1% in the right and 11.9 ± 3.0% in the left ACL. Averaged peak knee AP shear forces were 482.3 ± 65.7 N for the right and 430.0 ± 52.4 N for the left knees, approximately equal to 0.7-0.8 times body weight across both knees. A lack of symmetry was observed between the knees for valgus angles (p < 0.04), valgus moments (p < 0.001) and muscle activations (p < 0.001), all of which can be detrimental to ACL stability during impact activities. Comparisons between recorded EMG data and estimated muscle activations show the relation between electrical signal and muscle depolarization. In summary, this study outlines a musculoskeletal simulation approach that provides numerical estimations for a number of variables associated with ACL injuries in female athletes performing stop-jumps. PMID:23015067

Kar, Julia; Quesada, Peter M

2013-02-01

415

Assessment of quality of life of patients who underwent anterior cruciate ligament reconstruction and a rehabilitation program Avaliação da qualidade de vida de pacientes submetidos à reconstrução do ligamento cruzado anterior e a um programa de reabilitação  

Microsoft Academic Search

Introduction: Quality of life can be defined as the expression of a conceptual model that tries to represent patient's perspectives and his\\/her level of satisfaction expressed by numbers. The objective of this study is to evaluate the parameters of quality of life of 23 patients who underwent surgery for anterior cruciate ligament reconstruction. Methods: We adopted SF-36, a generic health-related

Priscila Zeitune Nigri; Flavia Machado Orlando; Ana Lucia; Wirz Gava; Maria Stella Peccin; Moises Cohen

416

Regulation of the inflammatory response by tin protoporphyrin IX in the rat anterior cruciate ligament transection model of osteoarthritis.  

PubMed

The purpose of this study was to investigate several inflammatory mediators and cartilage degradation molecules as possible biomarkers of joint lesion in the anterior cruciate ligament transection (ACLT) model of osteoarthritis in rats. We also assessed whether the treatment with the anti-inflammatory agent tin protoporphyrin IX (SnPP) reduces the progression of disease. Our results indicate that serum levels of interleukin (IL)-6 and PGE(2) are significantly increased in ACLT rats 10 weeks after surgery, whereas the increases in IL-1? and tumor necrosis-? were not significant. In addition, our data suggest that IL-17 is the main pro-inflammatory c